TSS Agency – Until the inauguration of the “El Alto Institute of Nuclear Medicine and Cancer Treatment”, at the beginning of this month, Bolivia had only one private center in this specialty, with little capacity for patient care. The new institute, built and equipped by the Argentine company INVAPwill provide care for people who require cancer diagnosis and treatment, with the capacity to serve 36,000 patients per year.
The creation of these centers is part of a framework agreement signed in 2014 and, in addition to construction and commissioning, includes training Bolivian professionals in Argentina at INVAP and at the Argentine Atomic Energy Commission (CNEA), that from now on a good part of the facilities located in the city of El Alto will operate.
In the El Alto nuclear medicine center they have two multimodality linear accelerators, brachytherapy equipment, a CT scanner, eight offices for cancer patients, seven armchairs and three stretchers for the application of chemotherapy with an infusion pump and clinical monitoring. In addition, there is a PET/CT tomography equipment and a SPECT/CT tomography equipment.
The manager of ICT projects and Technological Services of INVAP, Juan Carlos Rodríguez, told TSS: “Between the beginning and the end of the second half of this year, the next center will be operational, in Santa Cruz de la Sierra. As for the third, which is La Paz, we estimate that it will be between the fourth quarter of this year and the first of next year. The constructions are very advanced: in the case of Santa Cruz, in April we started with the installation of equipment and now comes the commissioning. That is where the problems will arise prior to the start-up of the services and it will take a few months until they are in a position to open the doors to patients”.
The activities of the nuclear medicine centers must comply with very strict international regulations and, as part of the agreement, during the first year of work the Argentine specialists will carry out the supervision and follow-up of the treatments, controls of the diagnostic reports and of the plans of radiotherapy. In parallel, the International Atomic Energy Organization will perform routine checks and support until all work plans are adjusted. It is expected that this accompaniment can improve the learning curves typical of the beginning of the activity.
The project also includes the sale of some of the supplies that these centers will need for their daily operation. “In principle, technetium generators, which are radioisotopes, are going to be produced in Argentina. For fluorodeoxyglucose 18 (FDG), which is used in PET, they are building a factory but they will only be able to produce in the second half of this year. Meanwhile, and for a logistics issue, they are going to cover that need with a product from Chile.”
Argentina is one of the most important countries in the production of radioisotopes and one of the most important competitors is Russia. Upon consultation of TSS On whether the war in Ukraine and the geopolitical sanctions against Russia could benefit Argentina as an exporter in the area, Rodriguez replied: “Russia is an important producer of radioisotopes and has specific agreements, for example, with Brazil, until they have ready the RMB 10 reactor, which is similar to the RA 10 that is being built in Ezeiza. The truth is that Argentina has several countries in the region as natural countries of its market. A little will depend on when the RA10 is finished, as to be able to increase the level of production”.
The number of patients that can be treated in these centers is usually conditioned by the number of work shifts that can be had. In El Alto there will be in the order of 25 to 30 patients for each of the two linear accelerators. The number of patients in brachytherapy is estimated at six patients per day and, in the case of PET, between five and six patients per team per day. In more general terms, a daily care of 120 people is estimated and that some 36,000 patients could be cared for annually. Of course there is also a learning process in between. “The curve to start the operation of a center of this type implies a learning process and corrections until it advances, and the incorporation of professionals is slow due to the training that people in the area require,” said the manager of INVAP.
The need for training professionals in Bolivia in the area of nuclear medicine is urgent. According to Rodríguez, “the nuclear doctors specialized in these teams, before this project, were five throughout the country. There is a PET in a private center and the rest were gamma cameras, which meant that few could access these treatments. There was a high percentage of society that could not access anything and those who had the economic opportunity to be treated left the country. In 2018, President Luis Arce had a tumor and had to go to Brazil for treatment. Today he is cured, with follow-up like any cancer patient, something that could not have happened in his country. And we are talking about a person with access to all the professionals in Bolivia.”
The total investment of the project is 149 million dollars for the three centers. For Argentina, these are high value-added exports generated in a relatively short period, although the pandemic delayed the plans drawn up after the 2014 agreement, since the centers had to be completed in 29 months and the training in four years.
The main equipment for these centers will be purchased abroad since only two companies manufacture it. “When I joined INVAP, in the 1980s, and started working on health issues and medical equipment in the radiotherapy area, there were more than 10 companies in the world that specialized in this, including INVAP. Today, in the Western world, two companies remained, Siemens (Germany) and Electra (Sweden). The development of this type of technology is so fast and the investments are so important that the central equipment ends up being bought and work is done on the auxiliary systems to integrate the correct functioning of the different equipment. These are developments that in some way also take advantage of everything that has to do with data science to improve tools, lower treatment costs and improve quality.”
At INVAP they expect to continue working on other projects with Bolivia, such as an initiative in conjunction with the CNEA to apply techniques of Boron Neutron Capture Therapy (BNCT, for its acronym in English), a technique for the treatment of certain types of cancer. “In the future, Bolivia would be an excellent place for a CAREM reactor when it goes from the prototype phase to serial construction, because the country has difficulties reaching certain places with high-voltage lines. One of only 25 MW could be installed that would serve to power a city or town but also to power the lithium industry, which has processes that require thermal energy to accelerate them. Many times people think of using the photovoltaic source, but it does not allow this type of process to be carried out, ”he explained.