While ANSTO is getting hundreds of millions for a new reactor, ostensibly to produce 'life-saving' medical radioisotopes, cyclotron-based Positron Emission Tomography is being starved of funds. In addition, an Australian doctor has had to pay $1 million from his own private practice to fund a radiotherapy machine. Articles on these topics below.

Some other points worth noting:

• at one stage in the 1980s, there were two continents on the planet without a medical cyclotron: Antarctica and Australia!
• in the 1980s, ANSTO was offered a cyclotron for free by the Australian National University, but ANSTO declined the offer. The cyclotron went to Japan and I'm told by an Australian nuclear scientist that the isotopes it produced were sold back to Australia.
• ANSTO owns and operates the National Medical Cyclotron in Sydney but has never used this cyclotron for cutting-edge research such as developing cyclotron methods of producing technetium-99m, the most commonly used diagnostic medical radioisotope. Compare this with the ingenuity being shown elsewhere - in the US for example, reactor supplies of the therapeutic cancer isotope palladium-103 dried up so an organisation developed a cyclotron method, and now a growing network of cyclotrons is producing palladium-103. Where there's a will there's a way ...
• in the mid-1990s, the federal Labor government rejected a thorough, costed proposal to pursue research into cyclotron production of technetium-99m.
• The 1995 Senate Select Committee on Radioactive Waste was urged, by Dr. Gary Egan and others, to recommend that $500,000 be spent over three years on cyclotron research. The Committee said in its report, "The Committee considers that Dr Egan’s submission comprises a modest request for research funding, the results of which may provide a useful basis for decision making associated with the replacement of Australia’s research reactor." (4.44, p.67) This recommendation has been ignored by Labor and Coalition governments alike.
• Dr. Lagunas-Solar from the University of California, a leading researcher into non-reactor methods of technetium-99m production, wrote to the Australian Prime Minister in September 1997 saying, inter alia, "It is my understanding that my work has been reviewed by ANSTO, without the benefit of my direct participation, and clearly using outdated and/or incomplete information. ANSTO also provided statements to Parliament based on information (also out of date) available through our internet site. Based upon a general analysis of ANSTO's review, I strongly feel that it does not provide an objective and balanced review of the actual status and/or the conclusions of our work."
• Dr. Rod Panter's Parliamentary Research Report, dated September 1997, concludes that: "It is clear that, in coming to a decision in principle to have a new reactor constructed in Australia, the Government has not made a thorough, balanced comparison of the merits of spallation sources versus the reactor method for technetium production."
• the US was going to build a billion dollar research reactor for scientific reearch but decided to build a spallation source instead
• the US was planning to use one of its own research reactors (Sandia) to produce technetium-99m but they've decided against that plan for the simple reason that there's a glut on the market and there will be a glut on the market for decades to come.

1. Doctors in cancer scan funding row (Sydney Morning Herald, 12 March, 2001)

2. Cancer patients miss out due to funding delay (Age website <www.theage.com.au>, 28 January, 2001)

3. New cancer therapy offers children hope (Sydney Morning Herald, 31 January, 2001)

4. Cancer machines running at half pace (Sydney Morning Herald, 18 July, 2001)

Senior Australian cancer doctors are engaged in an increasingly bitter dispute with the Federal Government over its approach to a costly new diagnostic machine.

They claim a Federal regulatory review of the machine is biased and deficient, and a decision to restrict Medicare funding is denying cancer patients best treatment.

However, despite growing use of the positron emission tomography (PET) equipment in the United States, the Government points to what it says is limited evidence of its effectiveness.

"This is a case of the technology outstripping government recognition of that technology," said Dr David Ball, an internationally recognised lung cancer specialist based at the Peter MacCallum Cancer Institute in Melbourne.

"If we use a CAT scan to determine whether a lung cancer has spread to the lymph glands, which are normally the first area, we're accurate about 60 per cent of the time," Dr Ball said. "But in PET scans we can do it in 90 per cent of cases."

PET uses mildly radioactive tracers injected into the body to find and illuminate cancers. It also has uses in diagnosing faults in the heart and brain.

A review of PET, endorsed by the Federal Health Minister, Dr Wooldridge, last year backed funding at seven facilities in Australia under Medicare.

Seven months later, funding arrangements are still "under development", according to the Health Department. Medicare rebates of $1,200 to $1,800 for scans are available at only one centre each in Sydney and Melbourne.
Attacks on the PET review that led to the Australian decision include one from a highly qualified specialist who contributed to it.

"I believe my work has been seriously misrepresented and inappropriately glossed over for reasons that are unclear to me," said the specialist, who declined to be named, in a letter to the Medicare Services Advisory Committee (MSAC).

A Health Department spokeswoman confirmed that it was considering a claim of misrepresentation, and had invited critics to provide MSAC with details of these criticisms.

There are also doubts over whether an expert supporting committee gave unqualified endorsement to MSAC. The Health Department spokeswoman declined to say whether there was such a division, but said varying opinions were to be expected.

A Tasmanian nuclear medical physician, Dr Rob Ware, said: "The thing we keep coming back to is that these are very serious conditions. Australians are dying like flies from cancer. Is this penny-pinching attitude appropriate?"

At Sydney's Royal Prince Alfred Hospital, surgeon Dr Brian McCughan benefits from a federally funded PET machine. But he said its use was too restricted. "I think we need more evidence when to use it, but I think it should be more widely available, yes."

The Federal Government's delay in allocating funding for a revolutionary cancer diagnostic tool is forcing thousands of patients to miss out on potentially life-saving treatment.

Australia's leading cancer diagnostic expert Rodney Hicks says it is inconceivable that the PET scan facility at the Peter MacCallum Cancer Institute could be limited to fee-paying patients because it was not available through Medicare.

Associate Professor Hicks, who is head of diagnostic imaging at the institute, said positron emission tomography, or PET scans, had proved more accurate than any other diagnostic device, including CAT scans, in tracing active tumors, enabling the most accurate treatment to be administered. He said it had saved hundreds of lives and thousands of dollars in inappropriate treatment and had the potential to revolutionise how cancer was treated. But, he said, despite the scientific evidence, the Federal Government was yet to allocate funding for the facility through Medicare.

Two years ago the institute applied to the Medicare Services Advisory Committee for funding for the facility, prompting federal Health Minister Michael Wooldridge to begin a nationwide feasibility study of PET scan facilities.
After the study was completed last year, the Health Department advised the nuclear medicine community the Federal Government would provide funding for seven facilities throughout Australia, including two in Victoria.
But the minister has yet to announce which hospitals will receive the funding, or how it will be allocated.
Professor Hicks said he believed it would be the end of the year before the Health Department made a decision and the institute could not sustain its operations until then.

There is also uncertainty about whether the Victorian Government will continue funding the facility this year.
The State Government has allocated the hospital between $300,000 and $400,000 for the past three years to enable Peter MacCallum patients free access to PET scans. All other patients must pay an $800 fee, placing the scans out of reach for many.

Professor Hicks said the hospital had received no indication of whether that funding would continue.
"It's inconceivable, (given) that I have seen 3500 patients, and done over 5000 PET scans over the last four years. We have a high international standing and yet we may not be funded," he said. "Life-threatening diseases are much more important, but we are paying for all sorts of things on Medicare which can never save a life. Without funding we won't be able to even provide the services for Peter Mac patients. It's gross inequality."

Professor Hicks said he believed the PET scan review had "suffered unduly" from the MRI controversy, which had forced funding to be reviewed more rigorously.

He said there was also concern that PET scan facilities were not cost-effective, but he said they actually generated cost savings by more accurately determining treatment.

"We are talking about a clever country. This is clever technology and we should be investing in it. At the same time, it's an affordable tool and could be even more affordable if we could get more people through it," he said.

Robert Burton, director of the Anti-Cancer Council of Victoria, said PET scanners were one of the most important steps in diagnosing cancer.

He said he did not believe every hospital should have a PET scanner and that two would be enough for Victoria "in the first instance".

A spokesman for federal Health Minister Michael Wooldridge confirmed the Health Department was going through a tender process for the facilities, but denied it was taking longer than normal.

The first radiation therapy machine in Australia that can treat brain tumours in children was unveiled yesterday.

But the doctor who introduced the machine to Sydney's Prince of Wales Hospital said he used $1million of his own money to pay for it, because the NSW Health Department would not fund additional radiotherapy services at the hospital.

The stereotactic intensity modulated radiation therapy equipment allows radiation beams to be focused in three dimensions, directly on a tumour. This is particularly useful for tumours around the brain and head, where more commonly used radiotherapy techniques result in high doses of radiation being applied to healthy tissues such as the brain, optic nerve or pituitary gland, to potentially devastating effect.

Senior oncology specialist Dr Robert Smee said that with traditional radiotherapy to the head, "if you treat a child less than age four, you get quite significant cognitive impairment". The stereotactic IMRT technique means healthy tissue receives only 10 per cent of the radiation usual with the older types of radiotherapy, so children are much less likely to be brain-damaged.

For adults and children, the ability to focus only on the diseased area means "we can now start pushing the doses up", which will improve cure rates, Dr Smee said.

For patients with cancers in the area behind the nose and throat, about 50 per cent would relapse after standard radiation treatment. Using the new targeted technique, a higher proportion could expect a full cure. But Dr Smee said there was already a two to three-month waiting list.

"The reality is a child jumps the queue," he said. Adult cancer sufferers had to wait longer, while those with benign tumours could expect the longest delays.

Even when a tumour was not cancerous it could cause serious problems, Dr Smee said. Benign pituitary gland tumours could cause people to "go blind, lose their balance. They're becoming anxious and fretful."

He expected waiting lists to become longer as people from other states became aware of the facility: under Medicare rules, anyone in Australia is entitled to the treatment.

"Here we have a world-class development and the hospital and the area [health service] and the [NSW] Health Department aren't prepared to contribute any money," he said.

Dr Smee said he had used funds from his own private practice over seven years to pay for the equipment, amounting to about $1million. He had done so "because ... I think we can do something important here".

A spokeswoman for the Health Department said replacement radiation therapy equipment was funded by several sources including the Federal Government, individual hospitals and area health services and community fundraising, as well as the State Government. She said the department met operating costs for existing radiation therapy machines and also paid for new ones. "In the last five years, NSW Health has spent in excess of $17 million on equipment alone," she said.

Nepean Hospital finally got its second radiotherapy machine in May. The linear accelerator was officially unveiled by the Health Minister, Mr Knowles, at a ceremony in the hospital's cancer care unit.

Designed to help shorten waiting lists of up to eight weeks for cancer patients, the $3 million machine was warmly welcomed by staff and the local Penrith community.

But two months later it is only being used until noon each day due to the lack of radiation therapists. That shortage is set to worsen in two weeks when the current manager of the machine, Mr Anthony Henrys, leaves to take up a position in an English hospital.

His departure highlights the major problem facing hospitals in NSW, and indeed around the country, in retaining radiation therapists.

Mr Henrys said yesterday he would be paid around $30,000 more a year to work at the United Kingdom's leading cancer centre, the Royal Marsden Hospital, which has a campus in Sutton, just out of London.

The 29-year-old admits he could have also got a job in Canada, Scotland, Sweden or Cyprus which would have paid substantially more.

"With the skills Australians have got they are in pretty high demand, because the way we are trained we can fully plan the treatment of patients as well as actually treating them," he said.

The Health and Research Employees Association says all 10 hospitals which provide radiotherapy treatment have 20-30 per cent of their radiation therapist positions vacant. In all but two, the operating hours of their linear accelerators have had to be restricted, forcing cancer patients to wait up to nine weeks for treatment.

The union has run a long campaign for higher pay for the radiation therapists, arguing that it was the best way to stop them heading overseas and interstate.

It was planning a stopwork meeting next Wednesday but that may now be averted after the Department of Health yesterday offered increases between 6 and 21 per cent - depending on the grade of the staff member.

A spokesman for Mr Knowles said a Government delegation to England early this year had prompted "eight to 10 serious expressions of interests".

But while the higher pay rates and recruitment campaign will ease the staffing crisis, it is of little comfort to patients waiting for treatment.

At the Nepean Cancer Care Centre, Mrs Rhonda Palmer waited yesterday for the radiotherapy she has been receiving daily for the past four weeks after a third bout of cancer following the removal of both her breasts.

One of the most difficult parts of her treatment has been waiting for six weeks for radiotherapy after finishing a course of chemotherapy.

"You really want this over as fast as you can. You want to get on with the rest of your life," Mrs Palmer said.

"The staff are really great but they are just run off their feet."