How a tertiary medical nuclear medicine department at the Himalayan area in India can be established and function in an exemplary manner. Basic rules revisited

Objective: We describe and discuss the various medical, social and financial aspects of setting up, and optimizing, working conditions of a tertiary Nuclear Medicine Department. This department was established in a North Indian state which comprises 93% of hilly area. During the first three years after establishment we have developed infrastructure, cooperation with other departments, improved radiation safety and cost effectiveness of our work and designed future perspectives. The facility was established in a cancer center of a tertiary care hospital where a medical college infrastructure was developed. National guidelines formulated by the Atomic Energy Regulatory Board (AERB) were followed. Our department served a population area of 10.08 million inhabitants. Over the first three years 2,400 patients underwent diagnostic scans and 106 patients underwent low dose radioiodine treatment for thyrotoxicosis. To optimize resources and at the same time, enhance their effectivity, we procured our Mo-99/Tc-99m generator every other week and arranged our daily programme accordingly. Fractionation of cold kits allowed us to perform low cost in-vivo procedures on a daily basis and to save the department's running costs by 30%-50%. We run continuing education nuclear medicine programmes for referring physicians, medical students and paramedical workers which were included in routine practice which led to a consistent growth in patients referral. The need for a positron emission tomography/computed tomography (PET/CT) scan and high dose treatment department for thyroid cancer was strongly felt. Conclusion: Our nuclear medicine department in a peripheral region of a developing country applied better logistics by procuring new generator every fortnight, fractionating the cold kits and by organizing complete teaching programmes.