Dear Members,

Dear Members & Colleagues,

The Nuclear cardiology society of India was initiated in year 1995 with goals to further the advancement of nuclear cardiology techniques in India. It is to be pondered by all the members of the group and referring physicians as to how far have we come and what are the remaining hurdles in popularizing this technology.

The utilization of robust, evidence based Nuclear Cardiology techniques like myocardial perfusion SPECT (MPS) for diagnosis of CAD, estimation of risk of adverse cardiac events, screening the individuals who need angiographic intervention with proven cost benefits shows significant variations across continents. In Asia too this variations are manifested across countries. Again within our country this trend continues, with more nuclear cardiology studies being performed in metro cities, specialty and corporate hospitals.

With the availability of newer tools there has been introduction of techniques like Rb-82 PET myocardial perfusion and 18F FDG myocardial viability studies at few centers in the country. SPECT-CT for the use of attenuation corrected perfusion SPECT studies and SPECT-64 slice CT angiography too have been started at some centers in the country. This is reflection of the quick adaptability of nuclear physicians to update and absorb newer more complex technologies.

Despite being blessed with highly trained Cardiologists, Cardiac surgeons and quickly adapting nuclear physicians, the utilization and introduction into screening algorithms of robust, evidence based MPS studies remains abysmally low in our country. With approximately 11% prevalence of coronary artery disease in adults and ever increasing population of diabetics resulting in manifestation of coronary disease in younger population, the utility and ability of cost effective screening tool like MPS to strategize the patients and their management cannot be emphasized more.

The reasons for low utilization of nuclear cardiology studies in India are rather complex. Unlike in USA the referring cardiologist in India is cut off from execution and interpretation of these studies. The inherent demarcation of role of nuclear physician and cardiologist in the Indian specialty training syllabi and the statutes of isotope regulatory authorities has designed the establishment of nuclear cardiology techniques under nuclear medicine rather than cardiology resulting in at times limited exposure of overlapping area of the other specialty. Further the lack of strong statutory, governmental, academic and reimbursement guidelines in the country add to the complexities that leaves the option of referral open to individual choice rather than being evidence based.

NCSI has to continue its awareness campaigns regarding cost effectiveness of this technology at various governmental and evolving health insurance sectors. Post-graduate training syllabi of both nuclear medicine and cardiology need to evolve to give greater exposure to relevant and longer training in overlapping areas. Possibility of having a cardiologist posted along with nuclear physician can be explored. Till some statutory evidence based mandatory guidelines evolve in Indian scenario, the best way forward remains, regular positive engagement with the referring cardiologist.

The new executive of NCSI strives to take forward the goals of the society with constructive inputs from executive and all the members.

Best wishes,
Prof. S Gambhir
President NCSI
Head Nuclear Medicine,
SGPGIMS, Lucknow