The origins of nuclear medicine in Cyprus
Nuclear medicine was introduced in Cyprus in 1972 by Dr. Aristides Costeas, who returned
to Cyprus in 1968 with a PhD in Biophysics from the Sloan Kettering Institute,
At that time, the Sloan Kettering Institute had a close association with the Memorial
Hospital in many fields. Both institutions collaborated closely in teaching and training
medical doctors and graduate students. In the field of nuclear medicine, the cooperation
was even closer. Clinical nuclear medicine was just being established, and research and
clinical applications were developing in parallel. At the Memorial Hospital there was
a close relationship between medical doctors and medical physicists, and a variety of
procedures were being tried and the results evaluated and discussed. Dr. Costeas participated
in these groups; his own research project was to study the comparative kinetics
of calcium and fluorine in bone using 18F and 47Ca, and his results proved very useful in
the development of the clinical procedures.
National milestones in nuclear medicine
1964 he Radiation therapy Department opened at Nicosia General Hospital.
1968 Dr. A. Costeas returned to Cyprus with a PhD in Biophysics from the Sloan Kettering
Institute, Cornell University.
1970 Cyprus Ministry of Health approval given for a radioisotope laboratory.
1971 Two IAEA fellowships granted to assist with the training of George and Pandelitsa
Maifoshi as technicians.
1972 The radioisotope laboratory was established at Nicosia General Hospital, the irst
equipment being a collimated gamma detector for 131I thyroid uptake and a well
A three-head gamma counter was purchased for renography.
A dual-head linear scanner with a six-colour printer was purchased.
1980 Dr. Krinos Trokoudes, a nuclear medicine and endocrinology specialist, returned
to Cyprus from Canada and established a private practice with a gamma camera
(Figs. 1 and 2 are drawn from his archive). He performed therapies with 131I.
1987 A gamma camera was purchased for the radioisotope laboratory at Nicosia General
1991 Dr. Charalampos Koursaros became the first nuclear medicine specialist to return
to Cyprus after finishing training in Greece. He started working at the radioisotope
laboratory in Nicosia General Hospital.
1992 the Cyprus Ministry of Health and the Society of Cancer Patients and Friends
provided a fellowship for Dr. Ourania Demetriadou, a radiologist, to be trained
in nuclear medicine in England.
1993 Dr. Ourania Demetriadou returned to Cyprus and commenced practice in
1996 Dr. Savvas Frangos, nuclear medicine specialist, and Dr. Kypros Kouris, medical
physicist, established a private practice in Limassol.
Dr. Sofoclis Sofocleous, nuclear medicine specialist, established a private practice
in Nicosia, with the first dual-head camera in Cyprus.
1999–today he American Heart Institute in Nicosia purchased a gamma camera and
provides nuclear cardiology services.
The Nuclear Medicine Department and the Thyroid Cancer Unit started working at
the Bank of Cyprus Oncology Centre under the leadership of Dr. Savvas Frangos.
A new dual-head gamma camera was purchased for the radioisotope laboratory
in Nicosia General Hospital.
The new Nuclear Medicine Department started working at Limassol General
Hospital, equipped with a dual-head camera.
Dr. Charalampos Koursaros established a new private practice in Nicosia with a
Establishment of the Cyprus Society of Nuclear Medicine
he Cyprus Society of Nuclear Medicine was formed in 1999 in Nicosia. Founding
members were nuclear medicine specialists, medical physicists, nuclear medicine technicians
and other doctors (cardiologists, oncologists) with a special interest in nuclear
medicine. The first president was Dr. Savvas Frangos. The society became a member of
the European Association of Nuclear Medicine and the World Federation of Nuclear
Medicine and Biology. The current president is Dr. Ourania Demetriadou.
Development of nuclear medicine in Cyprus
Whilst working in the Radiotherapy Department at Nicosia General Hospital following
his PhD and return to Cyprus, Dr Costeas’s first responsibility was to organise medical
physics for the Ministry of Health. However, his interest in nuclear medicine was such
that he considered returning to the USA. He informed the Ministry of Health of his
plans and explained the importance and the future of nuclear medicine. The Minister
was impressed, and gave his immediate approval for the creation of a Nuclear Medicine
Department in Nicosia General Hospital. Thereafter, Dr Costeas’s proposals were rapidly
The IAEA assisted with fellowships for training of the required personnel. In particular,
Dr. Costeas worked at the Royal Marsden Hospital with Dr. Trod (Director of Medical
Physics) and Dr. McCready (Director of Nuclear Medicine). Two IAEA fellowships were
granted for the training of two technicians, namely George and Pandelitsa Maifoshi.
These three comprised the team that initiated nuclear medicine in Cyprus. he equipment
was selected and arrived in 1972: a collimated gamma detector for 131I thyroid
uptake and a well gamma counter. Subsequently, a three-head gamma counter was purchased
for renography. Gamma cameras were filtering onto the market at this time, but
the price was beyond the limits of the budget, and so a dual-head linear scanner with a
six-colour printer was purchased.
he greatest challenge was to ensure that medical doctors were well informed about the
applications and about the usefulness of nuclear medicine in general. his was achieved
through lectures and seminars in hospitals, sending information leaflets to doctors, and
visiting their clinics to discuss the clinical significance of different procedures. he response
was very encouraging. New doctors coming from their training in England and
Greece began to arrive with information about nuclear medicine, and they were the arts
to use the tests. Each case was discussed with the referring physician, and especially the
abnormal cases were carefully considered. his approach proved very effective because
close cooperation was established between all departments.
he process was much easier with the in vitro tests. At the time there was no endocrinologist
in Cyprus and the diagnosis of thyroid disorders was based on the clinical
experience of the physician. thyroid function was followed by T3 uptake, T4, TSH and
eventually all radio-immunoassays. All tests were done manually and counted in a single
well counter. The World Health Organisation provided reference standards; the international
system of units was adopted, and a quality control system was set up. The curve
feeding programs used were a logit-Log curve plot program developed by the IAEA for
a tabletop computer from Olivetti. When tabletop computers from Apple became available,
in-house computer programs were developed for four-parameter curve fitting and
estimation of experimental errors.
The dual-head linear scanner was used for thyroid, brain, bone and liver scans. In
Cyprus at the time, echinococcosis was a quite common disease, with many patients
having hydatic cysts in the liver. The department was one of the first centres to use a
dual-isotope procedure to differentiate between vascular and non-vascular lesions in the
liver using labelled red blood cells (RBCs) and technetium colloid.
In 1980 a young doctor, Krinos Trokoudes, returned to Cyprus from Canada. Since his
particular specialisation in Canada had been nuclear medicine and endocrinology, he
obtained a gamma camera and started practicing in Cyprus.
Despite strong recommendations for the acquisition of a gamma camera, the approval
for this purchase repeatedly failed to be granted. The priorities of the governments
after the Turkish invasion in 1974 were to solve the problems of the refugees and to
build houses and new hospitals in areas where refugees settled. Funds were therefore
not allocated for nuclear medicine, and the linear scanner remained in use at Nicosia
General Hospital until 1986. However, the pressure for new and better tests continued
to increase, and in 1987 a gamma camera was finally procured.
Thallium-201 myocardial imaging and radionuclide ventriculography were implemented,
and quantitative SPECT for cardiac imaging followed. The calculated tomographic
images of the let ventricle were divided into 40 sectors and plotted as a bull’s eye plot.
The results were compared with averages taken from normal images and the difference
was plotted in the same way.
In cooperation with the cardiologists, comparative studies were performed with cardiac
angiographic evaluations. The results showed very good correlation. This helped
to convince the medical community of the importance of referring patients for nuclear
medicine studies before referring them for more invasive procedures.
Ventriculography was done using modified in vivo labelled RBCs using stannous
pyrophosphate and 99mTc-pertechnatate and multiple gated equilibrium blood pool imaging.
The end-systolic and end-diastolic multiple images total counts were used to
calculate the let ventricular ejection fraction. The results were considered useful for the
evaluation of patients with CVA.
Nuclear medicine in Cyprus today
thanks to the tremendous involvement of all those working in the field, nuclear medicine
is now a well-established specialty in Cyprus. All nuclear medicine examinations
and therapies, with the exception for the time being of PET applications, can be done
in Cyprus. Greater interest in nuclear medicine has now begun to develop amongst
young physicians. At present there are seven nuclear medicine centres and six nuclear
The future for nuclear medicine in Cyprus
The main future goal for nuclear medicine in Cyprus is the establishment of a PET-CT
centre. The problem of delivering FDG to Cyprus should be solved by establishing a
cyclotron on the island.*
Senior Medical Physicist, Member of the CySNM
*The text was published in the book “Nuclear medicine: fusing the ideas of Democritus and Hippocrates. Anniversary book of 25 years of the EANM” Editors :E. Bombardieri and S. Frangos in 2012
2017 Dr. Alexis Vrachimis became the Director of Nuclear Medicine at German Oncology Center Cyprus in Limassol with a PET/CT department and onsite Cyclotron