With the advent of so many private hospitals in Mumbai, it is peculiar to note that many of these ultra modern hospitals have no nuclear department. Just as MRI, CT and other imaging techniques are important for imaging the organs, the functional studies are important to decide the treatment in certain patients.

I thought of writing this article, after I was contacted by a patient from the suburbs. He had severe right-sided abdominal colic and the sonography revealed gallstones as well as kidney stones. The pain had lasted for 7-8 hours and the question was whether to do laparoscopic cholecystectomy urgently or put a ureteric stent after doing cystoscopy.

In a five star hospital, on an average, both these procedures cost Rs.50,000/- to Rs.100,000/-. One wrong advice from the doctor and the patient can end up with a financial burden.

In this case, the patient’s white cell count was around 12,000 and the urine showed only 2-3 RBCs. It was difficult to explain to his doctor that had there been a nuclear medicine department in that hospital, I would have asked for Isotope Hida Scintigraphy to confirm if the cystic duct was blocked. The latter is the best method to confirm if the patient has cholecystitis, and the gall bladder may then be removed immediately.

In another situation - coronary angiography is being done on a very large scale because the modern patients do not shy away from this procedure, which costs around Rs.15,000/- only. If the vessel is found to be blocked, an angioplasty with a stent is often advised, which could cost 1½ - 2 lakhs. The patient may arrange the money for fear of dying from a heart attack.

Not only that, the patient will also have to take Plavix for 6 months, which costs Rs.36,000/-. Even after stenting, he still faces 10% chance of stent closure. In case it closes, once again, he will have to spend a huge amount, creating a financial crunch in the family.

In such situations, the nuclear medicine department can come to the rescue. If the Thallium Myocardial Perfusion Scan shows more than 20% area of myocardial ischaemia, with dilatation of the heart and increased pulmonary uptake during the procedure, one should not hesitate to recommend angiography. But more important is, if it does not, then the patient may be treated with medical line of treatment.

Many renal angioplasties can be avoided. If the patient has renal artery stenosis, renal angioplasty should be done only if the Captopril Isotope Renogram is abnormal. I can quote many more examples, especially in the field of rejection of the kidney transplants, where the nuclear medicine department has proved a boon.

Finally, in modern days, no oncologist can treat his patient without the help of nuclear medicine department. In fact the progress, which has taken place in the field of oncology is not only due to modern drugs, but also due to better diagnosis with the help of nuclear medicine tests.