“What is nuclear medicine? Is it part of radiotherapy?” That was what I overheard a patient asking her relative outside my clinic door on one of my clinic days.
Not surprisingly, despite these services being available in the country for more than two decades, many Malaysians still do not know what nuclear medicine is all about.
In the mind of most people, the word “nuclear” is frequently associated with the atomic bombs that devastated Nagasaki and Hiroshima in Japan during World War II, as well as the nuclear plant disasters involving Chernobyl in the then-Soviet Union in 1986 and Fukushima, Japan, in 2011.
Who would have thought that nuclear medicine has been in existence even before the introduction of penicillin in 1940?
The term “nuclear medicine” is derived from the use of radioactivity harnessed from the unstable nucleus within an atom for medicinal purposes.
This harnessed radioactive energy can be used for imaging, as well as therapy.
The main concern for most people with regards to the use of nuclear medicine would be the amount of radioactivity they are exposed to.
The amount of radioactivity used for medicinal purposes is by far much lower and safer, compared to those used in nuclear power plants and consumer industries, or even in the dreaded nuclear weaponry.
The effective dose from the radioactive materials used is only as high as 14 millisieverts for nuclear medicine imaging.
Patients undergoing radiological examinations such as conventional x-rays, computed tomography (CT) scans and fluoroscopy are similarly subjected to radiation exposure.
To put things in perspective, everyone is subjected to natural background radiation (approximately 2.4mSv/year) of some kind or the other, be it from soil, food, water, space etc.
In fact, there are hotspots in the world such as in Ramsar (Iran), Guarapari (Brazil), Karunagappalli (India) and Yangjiang (China) where the citizens are exposed to higher natural background radiation (up to 260mSv/year) with no documented higher risk of cancer.
What is so unique about nuclear medicine?
There are various radioactive materials used for different purposes in this branch of medicine, such as technetium-99m, fluorine-18, gallium-68, iodine-131 etc.
These radioactive materials, when used by themselves or combined with specific tracers, are useful targeted imaging or therapeutic modalities for doctors.
Iodine-131, which is used for the treatment of well-differentiated thyroid cancer is a well-known theranostic agent (coined from the words “therapy” and “diagnostic”) that not only allows doctors to treat the cancer, but also see where the disease is located at the same time.
As a matter of fact, iodine-131 has been in clinical use since the 1940s.
In nuclear medicine imaging, two main types of scanners are required: the gamma camera and the positron emission tomography (PET) camera.
The scanners identify, as well as quantify, the distribution of the injected radiotracers (chosen based on their “target” properties).
For example, imaging of bone metastases for cancers such as breast and prostate cancers, are performed using bone-seeking technetium-99m-methyl disphosphonate.
This radiotracer is very sensitive in detecting early bone metastases, from as little as 5% abnormal bone turnover, compared to 40%-50% in conventional imaging.
The small amount of injected radioactive material would decay over time and is essentially harmless to the body.
This filepic shows a medical technologist looking at a PET/CT scan utilising radioactive material to visualise areas of disease.
The majority of PET/CT imaging performed worldwide uses fluorine-18-fluorodeoxyglucose.
This is a glucose analog, and hence distributes within the body to areas with high glucose consumption, particularly targeting cancers that are metabolically very active.
Doctors worldwide use fluorine-18-fluorodeoxyglucose PET/CT scans in the management of cancer patients, be it for assisting in biopsy, detection of the primary cancer site, staging, restaging, evaluating response to treatment, or surveillance.
This unique radiotracer can be used for various cancers such as head and neck cancers, lymphoma, breast cancer, lung cancer, melanoma, sarcoma, liver cancer, gastrointestinal tract cancer and gynaecological cancers.
In patients with lymphoma, fluorine-18-fluorodeoxyglucose imaging helps doctors stage the cancer and plan chemotherapy.
Subsequently, it is used to evaluate the effectiveness of the therapy and help the decision on whether to continue the chemotherapy or switch the regime.
For patients with lung cancer, this imaging is useful in assisting doctors to decide whether curative surgery is a viable option or to proceed with palliative chemotherapy.
With the development of targeted therapies such as tyrosine kinase inhibitors (TKI), this imaging is also useful in aiding doctors to decide if their patients would benefit from these expensive treatments, which can save lives and cost in the long term.
Similarly, the fluorine-18-fluorodeoxyglucose PET/CT scans can also be used to evaluate the response of TKI in the treatment of patients with refractory thyroid cancer.
Other PET tracers such as gallium-68-DOTATATE and gallium-68-PSMA, are now available in Malaysia and used for neuroendocrine and prostate cancers respectively.
The use of these gallium-68 tracers not only help with the staging of the disease, but also enables doctors to determine if the patient would respond to further radioactive therapies using yttrium-90 or lutetium-177.
The ability to combine the radioactive materials with specific targeted tracers makes nuclear medicine imaging an important cancer imaging tool.
Nonetheless, the use of PET/CT scans is not only limited to cancer cases, but can also be utilised for various other conditions, such as dementia, seizures, perfusion and viability of the heart, and even for fever of unknown origin.
Treating with radioactivity
In terms of therapy, nuclear medicine (using phosphorus-32) was first used in 1936 as a treatment for leukaemia.
As previously mentioned, iodine-131 has been used to treat well-differentiated thyroid cancer for over 80 years and remains the mainstay of treatment for patients who have undergone surgery to remove the thyroid gland.
Thyroid cancer is the ninth commonest cancer affecting women in Malaysia and iodine-131 therapy is fortunately available in most states in the country.
Besides well-differentiated thyroid cancer, iodine-131 is also useful in treating Graves’ disease, solitary toxic thyroid nodule and toxic multinodular goiter.
The role of nuclear medicine in cancer therapy is increasing rapidly with the availability of treatments for neuroendocrine and prostate cancers.
Other available nuclear medicine therapies include selective internal radiation therapy (SIRT) for hepatocellular carcinoma, radiosynovectomy for haemophilic arthropathy, and bone palliation for diffuse bone metastases.
Nuclear medicine definitely has an important role to play in medicine today and is in sync with the Precision Medicine Initiative launched by the former US President Barack Obama in 2015.
Though nuclear medicine has yet to be widely known among Malaysians, easy internet access to medical facts may soon change the scenario.
As pioneer radioactivity researcher Marie Curie once said: “Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less.”
Dr Alex Khoo Cheen Hoe is a consultant nuclear medicine physician. For more information, e-mail firstname.lastname@example.org. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
Skin is usually your body’s largest organ. It is a protective barrier that helps to regulate body temperature, and it also acts as a filter. The skin has a constant state of growth where old cells die, and new ones form. So, you need to keep your skin healthy so that it can fight potential diseases that are caused by the unhealthy skin. This article discusses ways on how to take care of your skin.
Know your Skin Type
It is important to know your type of skin. You either have a dry, normal, or oily skin. Some also have combination skin or sensitive skin.
Once you know where you belong, it will be easy to choose the suitable products to use on your skin. Not knowing what your skin type is may cause more harm for the products you use may react with it and bring skin conditions like acne. At birthorderplus, you can learn a lot about skin type and what to use to protect and treat your skin.
Healthy eating does not mean starving yourself. For your skin to look and feel good, you need to watch what you eat. Reduce foods high in cholesterol and sugars. You can replace these foods with vegetables and fruits.
Drinking lots of water will keep your skin smooth and hydrated. It is also believed that water is an anti-aging solution; it keeps your skin even and makes you look younger.
This is a very important aspect of taking care of your skin. This applies mostly to people whose daily jobs are done on open fields where the weather conditions are harsh.
You need to use protective oils on your skin before stepping out to the sun. Also, cover your skin properly when the weather is too hot or cold. It is also important to keep your body hydrated during hot weather for your skin gets affected more. Do not neglect your skin and expose it to direct sunlight.
It is also important to cover your eyes with sunglasses to protect the skin around your eyes and prevent early wrinkles.
This takes you back to knowing your skin type. You need to know what cleansers to use for your skin.
If your skin is oily, go for products that are calmer, do not strip off all oils from your skin, and those that will only lift excess oil and dirt from the pores.
You can scrub your skin before moisturizing it to remove dead skin and give room to a new one. You do not need to scrub it every day for this may cause skin irritation. Do it weekly or monthly depending on the nature of your daily job.
Skin is the first thing people notice when they look at you. Glowing skin is attractive and boosts your confidence. It may not be easy to keep your skin healthy, but it is worth the effort. You need to be cautious when choosing products for your skin and do not try to use what your friend uses for their smooth skin before knowing what you are putting on your skin.
Few reality cooking shows have engrossed viewers quite like MasterChef Australia, which features talented home cooks pitting their skills against each other.
And the finale of last night’s 10th season proved the show still has the goods.
In what turned out to be a tense but ultimately one-sided final, Singapore-born contestant Sashi Cheliah nabbed the title of MasterChef Australia and AUD250,000 (RM749,000), beating out fellow finalist Ben Borsht. Sashi scored the highest points in the show’s history, netting a total of 93 out of a possible 100 points against Borsht’s 77 points.
Born in Singapore, Sashi grew up surrounded by good food – his mother owned a café and his aunts were also really good cooks, so his fondest memories were of family members cooking up a storm. As an adult, Sashi spent a decade with the Singapore police force before migrating to Australia, moving first to Melbourne and then to Adelaide where he now works as a prison officer and lives with his wife and two sons. The move also inspired an increased desire to cook, and in an interview with The Straits Times, Sashi said he only seriously started cooking when he moved to Australia.
Sashi was a strong contender throughout the season, impressing the judges with his skills and bagging a historic two immunity pins.
Sashi was inspired to apply for the 10th season of MasterChef Australia following the death of his aunt, Letchmi. “She taught me how to cook … it was more for her I did the show,” he said in an interview with www.perthnow.com.au.
On MasterChef Australia, Sashi was a strong contender from the get-go and even achieved the remarkable feat of a double immunity pin, the only contestant in the history of the show to have attained hard-fought immunity not once, but twice!
Some of the dishes he made on the show were show-stoppers like chicken lemak and Malaysian pineapple tart with lime ice cream, both of which helped propel him to the finals of the show.
In yesterday’s finals, Sashi once again impressed judges George Calombaris, Matt Preston and Gary Mehigan when he shot to the lead with an impressive 57 points out of 60 for his starter of prawn sambal (which netted him three perfect 10s) and a main dish of fish curry with cumin rice. This gave him a whopping 16-point lead over Borsht who flailed in the challenge and scored 41 points.
In the finals, Sashi impressed all three judges with his prawn sambal and fish curry with cumin rice, which netted him near perfect scores. From left: George Calombaris, Gary Mehigan and Matt Preston.
“I just made sure there was enough flavour in my food to wow the judges. That’s all I did,” said Sashi in an interview with The Sydney Morning Herald.
But the toughest part of the night hadn’t even started yet. Both finalists were charged with recreating Heston Blumenthal’s monumental Counting Sheep dessert, a complicated looking ensemble that resembled a pillow suspended in air, and which used no less than 80 ingredients and 19 different techniques.
Given the complexity of the dish, Sashi and Borsht ended up making mistakes but recovered, with both scoring 36 out of a possible 40 points, and Sashi claiming victory with a total of 93 points.
At 39, Sashi is officially the oldest winner of MasterChef Australia and follows in the footsteps of previous winners like Julie Goodwin, Adam Liaw and last season’s Malaysian-born winner Diana Chan.
While he has indicated that his dream is to open a restaurant serving Indian and South-East Asian cuisine, he is also open to other opportunities.
“It’s giving me a stepping stone to go into the food world. I’m still looking at options… but I’m going to be trying a lot of things to see what suits me,” he said to Fairfax Media.
MasterChef Australia S10 airs on Lifetime (Astro Ch 709) Mondays to Fridays at 8pm.