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Technical progress has led to the merging of PET with CT (computed tomography), resulting in the spreading of so-called hybrid PET-CT equipment. The first PET/CT scan in Hungary was also performed with a radiopharmaceutical produced at the University of Debrecen in 2005. Since that time, the special imaging agent produced at the Medical Imaging Clinic of the University of Debrecen has been used not only in Hungary but also in Transylvania for diagnosing cancer patients.
Our institution has a decisive role in the production of radiopharmaceuticals for PET-CT studies in Transylvania, too. As radiopharmaceutical production is not yet available in Transylvania, meeting the overall demand is a major challenge for the production at the University of Debrecen. For the same reason, it is necessary to expand production capacity and to supply radiopharmacons produced in our region to as many foreign test sites as possible.
Positron emission tomography (PET) is mainly used in the diagnosis of cancer. The test involves injecting a molecule (radiopharmaceutical or radiopharmacon) labelled with a radioactive isotope into the patient and its distribution within the body is monitored by a PET machine that detects radiation, thus allowing the detection of pathological processes. The radioactive material needed for radiopharmaceuticals is produced in Hungary in particle accelerators (cyclotrons) at three sites, including the Nuclear Medicine Unit of the Medical Imaging Clinic of the University of Debrecen Clinical Centre.
“One of the most commonly used test materials is fluorodeoxyglucose (FDG) labeled with isotope 18F. In 2005, the first PET/CT scan in Hungary was performed with FDG produced in Debrecen. We have already delivered FDG from the radiochemistry department of Nuclear Medicine to various institutions within our country, including Budapest, Szeged, Gyula, Kecskemét and Kaposvár,” said Norbert Pótári, head of radiochemistry production.
The delivery of this special radiopharmaceutical and the production of the right quantity requires careful planning. The thing is that the half-life of FDG is two hours, which means that the activity of the triggered substance decreases by 50 percent every two hours.
“PET is a little bit more complicated than conventional imaging diagnostics because of the radiopharmacon. CT, for example, uses a contrast agent that is easy to access and the necessary amount can be precisely defined. In radiochemistry, this is a more complex process. The half-life of a radiopharmaceutical is two hours, so the production process has to take into account, among other things, the distance over which the radiopharmaceutical is transported and the number of examinations that are to be performed in a given institution. We have to calculate very precisely how much we need to produce so that the right amount of material with the right activity is delivered to the customer,” said László Balkay, scientific advisor and physicist at the Medical Imaging Clinic of the University of Debrecen Clinical Centre.
Careful planning and preparation allows the radiochemistry department to deliver the radiopharmaceuticals needed for the tests not only to domestic PET centers but also to foreign PET centers hundreds of kilometers away. In the future, they would like to increase their capacity so that more PET centers could use the special test material produced at the University of Debrecen for the diagnosis of cancer patients.
“The first PET/CT examinations in Bulgaria and Romania were also performed using our FDG. After Bucharest, we started to deliver to Cluj-Napoca, Timisoara and now also to Oradea and Tirgu Mures, covering practically the whole of Transylvania. It can be said that the role of the University of Debrecen is now indispensable in diagnosing the majority of Transylvanian cancer patients with FDG, and in the staging of the tumor, which is the key determinant of therapy. The demand is constantly increasing, as more and more PET-CT machines are being installed in Romania thanks to the favorable changes in the financing of PET-CT examinations. We would like to meet this growing demand by supplying our radiopharmaceuticals to as many foreign centers as possible. However, this requires further development and the expansion of our capacity,” said Ervin Berényi, Professor and Director of the Medical Imaging Clinic at the University of Debrecen Clinical Centre.
The growth of demand in Romania is clearly visible by taking a more specific look at the trend this year.
“At the beginning of the current year, we typically had 10 to 15 FDG production per week, of which we supplied to the PET centers in Debrecen, Cluj-Napoca and Timisoara. For Debrecen and Cluj-Napoca we typically delivered 1 or 2 times a day, while for Timisoara we delivered 1 time a day. During the year, two more PET centers are now to be supplied with FDG: Oradea and Tirgu Mures, 1-2 times a week for the time being. From 2025 onwards, their demand for FDG is expected to increase, but in addition, Cluj-Napoca has indicated that a new PET/CT testing site will be launched. The current level of demand can be met on a daily basis only with night shifts,” Norbert Pótári added.
The Nuclear Medicine Unit of the Medical Imaging Clinic of the University of Debrecen Clinical Centre currently produces five molecules for diagnostic use (18F-FDG, 18F-FET, 11C-methionine, 11C-choline and 68Ga-PSMA), which have a marketing authorization approved by National Institute of Pharmacy and Food Health (Országos Gyógyszerészeti és Élelmezés-egészségügyi Intézet).
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