Current Status of Nuclear Medicine Practice

in the Middle East

Diana Paez, MD,* Tarik Becic, PhD,* Uday Bhonsle, PhD, Amir R. Jalilian, PhD,
Rodolfo Nuez-Miller, MD,* and Joao Alberto Osso Jr, PhD
The practice of nuclear medicine (NM) in the Middle East region has experienced an important
growth in the last 2 decades and has become crucial in providing healthcare to the regions
population of about 395 million people. Even though there are some countries in which the
services provided are limited to basic coverage of studies with 99mTc and 131I, most have
well-established practices covering most of the available studies in this medical specialty; this is
the case in for example, Iran, Israel, Kuwait, Saudi Arabia, and Turkey. According to data
provided by the NM professionals in the 17 countries included in the present publication, which
was collected by the International Atomic Energy Agency in 2015, the total number of gamma
cameras in the region is 910 with an average of 2.3 gamma cameras per million inhabitants. Out
of these, 107 cameras, or 12%, are SPECT/CT cameras. There are 194 operating PET/CT
scanners, translating to one PET/CT scanner for 2.04 million people on average. The availability
of PET/CT scanners in relation to population is the highest in Lebanon and Kuwait, with 2.2 and
1.7 scanners per million people, respectively. There is a total of 628 NM centers in the
17 countries, whereas most NM centers belong to the public healthcare system and in most of
the countries are widely spread and not conned exclusively to capital cities. As for the
radionuclide therapies, 131I is used regularly in diagnostic workup as well as in therapeutic
applications in all the countries included in this analysis. Only ve countries have the capability
of assembling 99Mo-99mTc generators (Egypt, Iran, Saudi Arabia, Israel, and Turkey), and cold
kits are produced in several countries. Although there are no capabilities in the region to
produce 99Mo from nuclear reactors, a total of 46 cyclotrons are operated for production of PET
radionuclides. The most widely used PET tracer in the region is 18F-FDG followed by 18F-NaF;
concomitantly, the availability of 68Ge-68Ga generators is increasing and studies involving
prostate-specic membrane antigen or DOTA-chelated peptides or both are performed in at
least seven countries. Although therapeutic radionuclide agents are mostly imported from
outside the region, this does not limit the availability of therapies with 90Y, 153Sm, 177Lu, 131I,
188
Re, and 89Sr. Nevertheless, therapies based on alpha particle emitters are still largely not
available in the region and are currently only available in Israel and Turkey. Regarding human
resources, according to the data provided there are 1157 NM physicians, 1953 technologists,
586 medical physicists, and 173 radiopharmacists or radiochemists in the region. Approximately half of all available human resources are accounted for by Turkey. The region has great
potential for expanding the applications of NM; this becomes especially important in view of the
high prevalence of non-communicable diseases. Further increasing awareness of the clinical
applications of NM in healthcare and strengthening technical and human capacities including
the establishment of training programs for all professionals and disciplines in the eld are
recognized as key components in advancing the practice of NM in the Middle East.
Semin Nucl Med 46:265-272 C 2016 The Authors. Published by Elsevier Inc. This is an open
access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
*Division of Human Health, Department of Nuclear Sciences and Applications,
International Atomic Energy Agency, Vienna, Austria.
Division of Physical and Chemical Sciences, Department of Nuclear Sciences
and Applications, International Atomic Energy Agency, Vienna, Austria.
Address reprint requests to D. Paez, Division of Human Health, Department of
Nuclear Sciences and Applications, International Atomic Energy Agency
Vienna International Centre, Wagramer Strasse 5 - A2209, 1400, Vienna,
Austria. E-mail: D.Paez@iaea.org

Introduction

iddle East is one of the most dynamic regions in the

world. Characterized by a unique combination of
cultures, the region is experiencing rapid demographic and
socioeconomic changes. With its fast growing population,

http://dx.doi.org/10.1053/j.semnuclmed.2016.01.005
0001-2998/& 2016 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

265

D. Paez et al.

266
Table 1 Selected Demographic Data and Projections Per Country, Excluding Palestine
Country

Total Population
in 2014, in
Millions1

Projected Total
Population in
2040, in
Millions2

Surface
Area, km21

Population
Median Age in
2013, y4

World Bank
Income
Group1

Bahrain
Cyprus
Egypt
Iran
Iraq
Israel
Jordan
Kuwait
Lebanon
Oman
Qatar
Saudi Arabia
Syria
Turkey
UAE
Yemen
TOTAL

1.344
1.153
83.387
78.470
34.278
8.215
6.607
3.479
4.510
3.926
2.268
29.369
23.300
75.837
9.446
24.969
390.558

1.760
1.351
113.001
96.772
59.614
11.280
8.997
5.610
4.662
5.007
2.912
38.193
35.486
91.778
14.064
38.769
529.256

760
9.250
1.001.450
1.745.150
435.240
22.070
89.320
17.820
10.450
309.500
11.610
2.149.690
185.180
783.560
83.600
527.970

30.1
35.2
25.2
28.5
19.7
30.1
23.4
29.2
29.8
26.3
31.7
27.5
22.4
29.4
30
19.1

High
High
Lower middle
Upper middle
Upper middle
High
Upper middle
High
Upper middle
High
High
High
Lower middle
Upper middle
High
Lower middle

capacity building, and expansion of medical services are of

high priority in this region. In this article, we apply the
geographical rather than the political principle in dening
the region, while also considering the status of nuclear
medicine (NM) in terms of equipment, human resources,
availability of radiopharmaceuticals, and type of diagnostic
and therapeutic procedures performed. Although there is
no unique denition of the region of Middle East and it
varies from one source to another, the authors considered
the inclusion of the countries specied below to be
important for the purpose of this issue of the Seminars in
Nuclear Medicine: Contributions to Nuclear Medicine from the
Middle East. Accordingly, we provide analysis of the
situation in Bahrain, Republic of Cyprus (in further text
as Cyprus), Arab Republic of Egypt (in further text as
Egypt), Islamic Republic of Iran (in further text as Iran),
Iraq, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian
Territory (in further text as Palestine), Qatar, Saudi Arabia,
Syrian Arab Republic (in further text as Syria), Turkey,
United Arab Emirates (in further text as UAE), and Yemen.
Human resources and availability of technology along with
the production and supply of radiopharmaceuticals play a
critical role in ensuring high quality of NM practice. This article
provides information regarding the status of NM instruments,
professionals, training programs, production and supply of
radiopharmaceuticals, and future trends and needs in the
region and can serve as an incentive to strengthen the practice
of NM.

Demographic Data
Egypt is the most populous country with about 83 million
people in 2014, followed by Iran with roughly 79 million
inhabitants and Turkey with an approximate population of

76 million people. The population of Cyprus is the smallest, comprising 1.15 million people, followed by Bahrain
with 1.34 million.1 The total population of the region is
395 million people, and is projected to increase by 140
million people in the next 25 years, reaching 529 million.2
Saudi Arabia encompasses the largest territory in the
region, whereas Iran and Egypt take the second and third
place, respectively.1 The median age of the population was
set at between 19.1 years in Yemen and 35.2 years in
Cyprus.3 Great economic disparities exist between the
countries. Table 1 demonstrates some demographic characteristics of the Middle Eastern countries.

Health Indicators
Table 2 shows the wide range of life expectancy at birth. The
average of 75 years as well as life expectancy in most of the
countries individually was higher than the world average of 71
years. Adult mortality rate was lowest in Kuwait (52 per 1000
population), and highest in Yemen (232 per 1000 population).3 Cardiovascular diseases (CVDs), cancers, diabetes, and
chronic respiratory diseases as main non-communicable diseases (NCDs) are associated with a probability of premature
death varying between 9% in Cyprus and Israel and 25% in
Egypt.4
Risk factors for NCDs (Table 3) are present in a large
percentage of population in the region. Obesity represents a big
challenge and affects as much as 50% of all adult women and
42% of the total adult population in Kuwait (2008). In
Lebanon, one-third of all adult men and 29% of the countrys
adult population suffer from raised blood pressure (2008).4 An
estimated 17% of Egypts adult population was diagnosed with
elevated fasting blood glucose.3 The NCDs account for a great
portion of total mortality in the region and are responsible for

Practice of NM in the Middle East

267

Table 2 Life Expectancy at Birth, Adult Mortality Rate and Premature NCDs-Associated Mortality Per Country, Excluding Palestine
Country

Life Expectancy at Birth in

2013, Total, y 1

Adult Mortality Rate in

2013 (Probability of Dying
Between 15 and 60 y/1000
Population)3

Premature Mortality Due to

NCDs (Probability of Dying
Between 30 and 70 y Due to
Four Main NCDs in %)4

Bahrain
Cyprus
Egypt
Iran
Iraq
Israel
Jordan
Kuwait
Lebanon
Oman
Qatar
Saudi Arabia
Syria
Turkey
UAE
Yemen

77
80
71
74
69
82
74
74
80
77
79
76
75
75
77
63

64
56
156
119
153
56
114
52
59
100
67
80
95
109
76
232

13
9
25
17
24
9
20
12
12
18
14
17
19
18
19
23

more than half of all deaths in all the countries except Yemen
(39%) and Syria (46%), reaching levels as high as 86% in
Turkey and 90% in Cyprus. Specically, CVDs make up the
biggest part of the NCDs related death burden in all countries,
with Turkey and Lebanon carrying the largest burden, where
CVDs are the cause of death in 47% of all cases; except in Israel,
where cancer kills more people than CVDs. Rates of diabetesassociated mortality vary between 1% in Syria and Egypt and
as high as 13% in Bahrain.4
With already high prevalence of NCDs and the associated
mortality, as well as because negative health trends such as ever
growing obesity rates threaten to worsen the situation and
overburden the healthcare systems in the future, identifying
appropriate management strategies is of utmost importance. As
NM plays a crucial role in the diagnosis, risk stratication and
management of most NCDs, its practice in the region should

be up-scaled for efcient and cost-effective management of

these diseases.

Available Technology
There is great heterogeneity as to the availability of technical
capacities in the region with some countries having state-ofthe-art technology including cyclotrons and PET/CT. According to data provided to the International Atomic Energy
Agency (IAEA) in 2015 by NM professionals in the region,
the total number of gamma cameras available is 910 including
107 SPECT/CT systems with Turkey, Iran, Israel, and Saudi
Arabia having 310/12, 200/8, 63/26, and 49/34 SPECT/
SPECT-CT systems, respectively (Table 4). The ratio of gamma
cameras per million population ranges between 0.1 in Iraq and

Table 3 Specic and Total NCDs-Associated Proportional Mortality Per Country in 2014 in Percentages4, Excluding Palestine
Country

Cardiovascular
Diseases

Cancers

Diabetes

Chronic Respiratory
Diseases

Other NCDs

Total

Bahrain
Cyprus
Egypt
Iran
Iraq
Israel
Jordan
Kuwait
Lebanon
Oman
Qatar
Saudi
Arabia
Syria
Turkey
UAE
Yemen

26
38
46
46
33
26
35
41
47
33
24
46

13
24
14
13
10
27
15
14
22
10
18
10

13
7
1
2
4
6
7
4
4
10
9
5

6
5
4
4
3
5
3
2
4
2
1
3

20
16
19
11
12
22
16
12
8
13
17
14

78
90
85
76
62
86
76
73
85
68
69
78

28
47
30
21

10
22
13
5

1
2
3
2

2
8
3
3

5
7
16
8

46
86
65
39

D. Paez et al.

268
Table 4 List of Available Infrastructure in the Region, Data Obtained From Nuclear Medicine Professionals
Number of Centers and Available Equipment in the Middle East
Country

NM Centers Gamma Cameras SPECT/

CT

Bahrain
3
Cyprus
6
Egypt
58
Iran
155
Iraq
6
Israel
40
Jordan
14
Kuwait
12
Lebanon
27
Oman
2
Palestine
1
Qatar
2
Syria
4
Saudi Arabia 41
Turkey
240
UAE
13
Yemen
4
TOTAL
628

3
9
65
200
5
63
13
30
27
3
1
3
2
49
310
15
5
803

1
2
9
8
0
26
0
6
1
2
0
1
2
34
12
3
0
107

Gamma Cameras PET/

Per Million People CT

PET/CT Per
Million
People

Cyclotrons

3.0
9.5
0.9
2.6
0.1
10.8
2.0
10.3
6.2
1.3
0.2
1.8
0.2
2.8
4.2
1.9
0.2

0.7
0.9
0.2
0.04
0
1.1
0.9
1.7
2.2
0.5
0
0.4
0.1
0.4
1.6
0.4
0

1
0
3
4
0
4
2
2
2
1
0
1
1
6
16
3
0
46

1
1*
15
3
0
9
6
6
10
2
0
1
2
13
122
4
0
194

*This PET/CT is installed at the Near East University Nicosia, North Cyprus and due to absence of information on the remaining infrastructure of this
center, it is not included in the overall statistical analysis.

10.3 in Kuwait and 10.8 in Israel. There are 194 operating

PET/CT scanners, translating to one PET/CT scanner for 2.04
million people on average in the region. Lebanon with 2.2 and
Kuwait with 1.7 PET/CT scanners per million people are the
leading countries regarding the availability of PET/CT scanners
relative to population. To the best of our knowledge, the
number of NM centers in the region is 628; 240 of them being
located in Turkey and 155 in Iran (Table 4). Most NM centers
are part of the public healthcare system and are generally
widely spread across the country and not only conned to
capital or major cities.
Regarding the availability of cyclotrons for production of
PET radioisotopes (Table 4), there are currently 46 operative
cyclotrons in the region devoted mainly to the production of
18
F; in addition, Israel, Lebanon, Turkey, Saudi Arabia, and
Syria have capabilities to produce 11C. The availability of
68
Ge-68Ga generators is augmenting and countries such as
Iran, Israel, Jordan, Kuwait, Lebanon, Saudi Arabia, and
Turkey already perform studies with prostate-specic membrane antigen or DOTA-chelated peptides or both.

Human Resources and Education

NM Physicians
In many countries of the region, NM is a specialty obtained by
physicians after an MD degree in 4-5 years. The introduction of
hybrid imaging modalities for example, SPECT/CT and PET/
CT has attracted radiologists to the eld of NM. There are
approximately 1157 NM physicians in the region (Table 5); the
number of physicians per equipment including SPECT and
PET varies between 0.4 in Lebanon and 2.2 in Iraq (Fig.).

Radiopharmacists or Radiochemists
Albeit the scarce number of radiopharmacists or radiochemists
in the region, the NM specialty has grown in the last 2 decades.
In total, there are approximately 173 professionals with
training in these disciplines (Table 5), in most of the cases
obtained abroad. However, with growing research and development infrastructure in some countries the need for training
scholars with highest academic degrees has been brought
about, and in certain countries for example, Iran and Turkey
academic training programs in radiopharmacy or radiochemistry already exist at PhD level. To fulll the need for
sustainable services at hospital radiopharmacy facilities,
degrees at technician level in radiopharmacy or radiochemistry
or onsite training for individuals who have obtained basic
science degrees have been established in many countries.

Medical Physicists
According to the denition of the IAEAs International Basic
Safety Standards,5 a medical physicist working in a clinical
environment is: a health professional, with specialist education and training in the concepts and techniques of applying
physics in medicine, and competent to practice independently
in one or more of the subelds (specialties) of medical physics.
In the eld of NM their role is pivotal, they usually participate
in several tasks,6 such as the establishment of institutional
radiation protection programs, quality control of NM instruments, and optimization of NM clinical procedures, including
acquisition and processing protocols. Moreover, because of the
increasing number of cases of radionuclide therapy in different
clinical centers in the region, personalized clinical dosimetry in
medical practice has strengthened their roles. According to the

Practice of NM in the Middle East

269

Table 5 List of Available Human Resources in Nuclear Medicine in the Region, Data Obtained From Nuclear Medicine Professionals
Country

Radiopharmacists/
Radiochemists

Medical
Physicists

Technologists

Nuclear Medicine
Physicians

Bahrain
Cyprus
Egypt
Iran
Iraq
Israel
Jordan
Kuwait
Lebanon
Oman
Palestine
Qatar
Saudi Arabia
Syria
Turkey
UAE
Yemen
TOTAL

2
0
12
23
5
5
5
10
4
0
0
3
25
5
70
2
2
173

2
7
32
123
21
7
20
10
7
14
0
3
60
25
250
2
3
586

5
10
95
400
10
85
34
150
50
17
1
13
172
10
850
45
6
1953

5
7
105
200
11
75
29
50
15
9
1
5
79
10
535
15
6
1157

information provided by the different countries there are 586

medical physicists working in the eld of NM in the region
(Table 5), some of them also providing support to radiotherapy
departments.

Technologists
Like in other parts of the world, the shortage of technologists is
a common problem in the region. The total number of
technologists approximates to 1953 (Table 5), and the availability per camera (including SPECT and PET scanners) varies
between 0.9 in Israel and 3.6 in Kuwait (Fig.). The high ratio in
Kuwait is partly due to the fact that technologists in the country
do not provide support only to NM procedures, but rather to
all diagnostic imaging modalities. Training programs for
technologists in NM are available in the form of a Bachelors
degree in Egypt, Iran, Jordan, Kuwait, and Turkey and Masters
in Science degree in Israel, whereas other countries mostly rely
on onsite training. In most cases, the training is not focused on
NM only but covers other areas of radiation medicine such as

Figure Number of physicians and technologists per equipment

(PET/CT, SPECT and SPECT/CT).

radiology and radiotherapy. In addition, technologist positions

are frequently occupied by licensed biologists or laboratory
technicians.

Types of Procedures and Availability of

Radiopharmaceuticals
The availability of diagnostic and therapeutic radiopharmaceuticals in the region is heterogeneous (Tables 6 and 7).
Regarding radiopharmaceuticals used for SPECT imaging, all
countries have 99Mo-99mTc generators, although only Egypt,
Iran, Israel, Saudi Arabia, and Turkey have the capabilities of
assembling the generators. 131I is widely accessible for both
diagnostic and therapeutic purposes. Despite the overall
presence of PET scanners in the region, 67Ga citrate is still
being used in most of the countries (Table 6). Studies
performed with 111In for evaluation of infection and neuroendocrine tumors, among other indications, are performed in
all the countries other than Cyprus, Iraq, Palestine, and Yemen.
Data obtained from the IAEA Nuclear Medicine Database
(NUMDAB),7 which represents about 15% of all NM departments in the region, show that nearly 80% of procedures
performed in a typical setting are diagnostic NM procedures,
excluding PET/CT. As in other regions, bone and cardiac
studies are the most common procedures performed, accounting for 30% and 20% of the total studies, respectively, followed
by endocrine and renal studies. However, there is increased use
of therapeutic agents such as somatostatin peptide analogs
labeled with 177Lu or 90Y for neuroendocrine tumors and
90
Y-labeled anti-CD20 monoclonal antibodies for lymphoma.
As for PET radioisotopes, 18F is produced in the 13 countries
which have operating cyclotrons (Table 4), 18F-FDG being the
most commonly used tracer, followed by 18F-NaF. Israel,
Lebanon, Turkey, Saudi Arabia, and Syria perform studies with
11
C (Table 6). Concomitantly, the availability of 68Ge-68Ga

D. Paez et al.

123

Tl

201

111
InInOctereos- DTPA
can
111

Inoxine

111

IDatscan

From the technical point of view, radiolabeling, quality

assurance, dispensing, and packaging of the radiopharmaceuticals also differs from one country to another. Iran, Israel, and
Turkey have the most developed capacities for production and
distribution. Various international companies from outside the
region such as Nordion, Mallinckrodt, Polatom, and Izotop are
active in the Middle East; this combined with the presence of
regional companies such as Monrol and Pars Isotope ensures
the wide availability of radiotracers and all NM procedures,
both in diagnostic SPECT and PET imaging as well as in the
therapeutic area. The activity of these commercial companies
not only has fullled the existing demand of the region, but has
also increased the rate of development and cost-effectiveness of
procedures.

81

Rb-81m- 67Ga
Kr
citrate
generator

123

I-NaI

123

generators is increasing and studies involving prostate-specic

membrane antigen or DOTA-chelated peptides or both are
performed in Iran, Israel, Jordan, Kuwait, Lebanon, Saudi
Arabia, and Turkey. 13N and the tracer 13N-NH3 are used in
Israel, Jordan, Kuwait, Lebanon, Qatar, Saudi Arabia, and
UAE; whereas 82Sr-82Rb generators are being used in Jordan,
Kuwait, and Saudi Arabia. Cardiac studies with 201Tl are still
performed in many centers across the region (Table 6). In
general, according to the IAEA NUMDAB,7 PET applications
currently represent about 16% of total NM studies performed
in the region.
Regarding radionuclide therapies, as indicated in Table 7,
131
I is widely available for management of patients with
hyperthyroidism and thyroid cancer. 131I-MIBG is used in all
the countries except for Bahrain, Iraq, Kuwait, and Palestine.
Bone pain palliation with 153Sm or 89Sr is performed in all the
countries with exception of Iraq, Palestine, and Yemen. On the
contrary, therapies with 177Lu are limited to Iran, Israel,
Jordan, Kuwait, Lebanon, and Turkey. Furthermore, 188Re is
being clinically used in Egypt, Iran, Israel, Jordan, and Turkey.
Finally, alpha emitters such as 223Ra are therapeutically applied
solely in Israel and Turkey.

Production and Distribution of

Radiopharmaceuticals

Bahrain
Cyprus
Egypt
Iran
Iraq
Israel
Jordan
Kuwait
Lebanon
Oman
Palestine
Qatar
Saudi
Arabia
Syria
Turkey
UAE
Yemen

131

99
Mo-99mTc
generator

Country

Table 6 List of Available Diagnostic Tracers in the Region, Data Obtained From Nuclear Medicine Professionals

131

IMIBG
IMIBG

18

F-FDG

18

F-NaF

13

N-NH3

68
Ge-68G- 11Ca
radiotragenerator cers
68
/ Garadiotracers

82
Sr-82Rb
generator

270

Cold Kit Laboratories

As the most important source of radiopharmaceuticals, 99mTc
cold kits still play an essential role in the NM practice and some
member states in the region have developed stable and
sustainable cold kit preparation units in the last 3 decades.
Apart from the simple small molecule kits, recently many
biomolecular kits have been introduced and entered the
clinical trials in the regions countries such as peptide and
antibody kits, owing to the existing infrastructure as well as a
result of different IAEA initiatives.8

Research and Development

As mentioned earlier, the availability of qualied human
resources as well as the existence of radionuclide production
infrastructure including cyclotrons of various particle

Practice of NM in the Middle East

271

Table 7 List of Available Therapeutic Agents in the Region, Data Obtained From Nuclear Medicine Professionals
Country

131

Bahrain
Cyprus
Egypt
Iran
Iraq
Israel
Jordan
Kuwait
Lebanon
Oman
Palestine
Qatar
Saudi Arabia
Syria
Turkey
UAE
Yemen

131

I-MIBG

32

90

153

89

Sm-EDTMP

accelerating energies, research reactors and laboratories, has

enabled the production of a variety of radioisotopes and
radiopharmaceuticals. These developments have made it
possible to move beyond the classical PET radiotracers
produced in small medical cyclotrons, allowing 13N-NH3
and in some cases 11C tracers to be produced.
The operation of cyclotron machines with more than
25 MeV accelerated protons not only led to the local production of routinely used SPECT tracers such as 67Ga, 201Tl, 123I,
and 111In, but also sparkled the initiation of research and
development of various radionuclides such as copper radionuclides, 68Ge, 103Pd,9 and 57Co in some member states also
with the help of the IAEA. Furthermore, many member states
have been successful in the production and formulation of
therapeutic radiopharmaceuticals with reactors with the help
of IAEA coordinated research and technical cooperation
projects.

Discussion
The average number of gamma cameras including SPECT/CT
systems per million people in the region is 2.3, with a range of
0.1 in Iraq to 10.3 in Kuwait and 10.8 in Israel. This is lower
than the average ratio in Latin America of 2.6,10 Europe 5.57,
Canada 20.35,11 and USA 47.2.12
The availability of PET/CT in the region is one scanner per
2.04 million people, and relative to the population, Lebanon
(2.2) followed by Kuwait (1.7) have the highest number of
scanners per million people. Recommendations provided in
literature that takes into account global, nonspecic data,
suggests that the number of scanners should be 1.0-1.5 per
million inhabitants.13 In a well-developed context, expectations are that this gure would rise to 2.0-2.5 scanners per
million population.14 It becomes increasingly evident that
there is room for growth and development in the region to
install more PET/CT scanners and keep up with the support
needed to address the high incidence of NCDs.

Sr

177

188

Lu

Re

Alpha Emitters

Regarding the general status of NM in the Middle East, the

wide-range availability of almost all current diagnostic and
therapeutic applications is recognized as a strength. The
growth in technology and human resources provides a strong
incentive for further consolidation of the specialty and
expansion of services provided.
The fact that the vast majority of NM centers belong to the
public healthcare sector underlines the governmental support
and acknowledges the importance of clinical applications of
NM.
Even though training programs at university level are
available in some countries for all the professional disciplines
involved in the practice of NM, for example, NM physicians,
medical physicists, radiopharmacists or radiochemists, and
technologists, there is a clear need of expanding the coverage
and establishing new academic programs to cover the needs of
the region and enable further growth. Intraregional initiatives,
such as the establishment of the Arabic Society of Nuclear
Medicine, could provide strong incentives towards strengthening the training programs in the region. The fact that some
countries have very advanced status of NM practice provides
an additional strong argument in support of regional
cooperation.
Research and overall development activities in the Middle
East are clear indicators of the advancements in NM that the
countries have made. However, we acknowledge that some
countries in the region have still not acquired important NM
technologies, such as cyclotrons and PET/CT scanners, and
efforts should be made to mobilize all stakeholders at national,
regional, and international level to strengthen the resources
and enable further growth of this medical specialty.

Conclusion
Countries in the Middle East have witnessed an important
growth of NM in the past decades. Although there are
profound differences in the region regarding the availability

D. Paez et al.

272
of human as well as technical capacities, it is also evident that
the practice of this medical specialty has seen an overall
advancement. This is reected in the general availability of
current NM diagnostic and therapeutic procedures, as well as
the ever growing number of technologies installed. However,
there is a shortage of well-structured training at academic
institutions in the region, and there is a need to establish and
expand training programs for all disciplines involved in the
specialty. Furthermore, we note that PET/CT is still not
available in some countries of the region. Also, there is a need
for further raising of awareness of the usefulness of clinical
applications of NM techniques. Addressing these limiting
factors, along with strengthening intraregional and international cooperation, would enable further growth and upscaling
of NM in the Middle East, which is of utmost importance in the
wake of the growing incidence of NCDs in the region.

Disclaimer
The depiction and use of boundaries, geographic names, and
related data shown on maps and included in lists, tables,
documents, and databases on this article are not warranted to
be error free nor do they necessarily imply ofcial endorsement
or acceptance by the United Nations.

Acknowledgments
The authors would like to thank all colleagues at the NM
centers in the region for sharing the information in the
preparation of this publication.

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