Letter to the editor
Abstract
Montevideo, July 14, 2006
Mr. Director of the Editorial Board of the
Medical Journal of Uruguay
Dr. Ariel Montalbán
Present
From my consideration:
I am pleased to address you in order to express my point of view on the validity of positron emission tomography (PET) techniques in the national health and academic context.
The economic resources allocated to health in our country have been limited in recent years. In this sense, it is logical that their distribution be carried out according to the priorities with the greatest social impact. On the other hand, the introduction of new diagnostic tools of proven benefit must respect the fundamental ethical principle according to which universal and equitable access of the population to health services of proven quality is ensured. On the other hand, these new health technologies take on special importance if they are applied to the clinical management of pathologies of high incidence and national prevalence. As is known, in our country, cardiovascular diseases and cancer are the first and second causes of mortality in the country, respectively.
The vast majority of academic PET centers are based on the context of university hospitals, where teaching and research are carried out as well as assistance. In them, care tasks related mainly to the diagnosis of neoplastic patients are carried out. They are performed with 18F-2-fluorine-2 deoxy-D-glucose (FDG), constituting techniques that have already been transferred to the clinical routine of care. However, there is an important area of research and development that also involves short half-life tracers. For these purposes, it is highly desirable that the cyclotron (producer of positron-emitting radioisotopes) is located in the same physical location as the PET cameras. By way of example, many of the receptors, ligands, neurotransmitters and drugs that act at different levels of the central nervous system can be labeled with 11C (20 min half-life). In this sense, 11C-choline has shown utility in the staging of patients with prostate cancer, a pathology for which FDG PET has low sensitivity. Indeed, this short half-life radioisotope is of great interest for its chemical flexibility and for the specificity of the molecular images it provides.
There is no doubt that PET-cyclotron technology allows the development of a large field of basic and applied research. In this way, not only the clinical impact of the different interventions that this procedure can perform in health should be considered, but also its contribution to the knowledge and understanding of the tumor phenotype (and in the near future) of the genotype itself. Therefore, these studies must necessarily be developed in academic centers of excellence.
As is well known, the Hospital de Clínicas "Dr. Manuel Quintela" is a university hospital, general, for adults, of high complexity and of national reference as far as it is concerned. It is based on an academic environment in which knowledge of health-disease processes is created, concentrated, taught and disseminated, in the context of the University of the Republic with which it shares philosophical and legal bases. For this reason, the hospital must constitute an authentic reference in health technology, incorporating, evaluating, disseminating and using appropriate technologies, supported by solid knowledge of their safety, effectiveness, efficacy and efficiency.
