Nuclear Medicine Clinic in Bern: Prof. Dr Axel Rominger

Prof. Dr Axel Rominger is Clinic Director of the renowned University Clinic for Nuclear Medicine in Bern. The established specialist for nuclear medicine also holds the position of Chief Physician at the Inselspital Bern. Prof. Rominger's clinical and scientific focus includes nuclear medicine diagnostics using PET/CT as well as new therapeutic procedures in nuclear medicine. Due to his high level of expertise, the respected expert was appointed as a full professor at the University of Bern. 

Medical and Technical Excellence in Nuclear Medicine in Bern

The range of services offered by the Inselspital Bern cover the entire spectrum of nuclear medicine – be it in the field of diagnostics or therapeutic approaches. The University Hospital in Bern is one of the leading university hospitals in Switzerland and has also made a name for itself internationally. The Nuclear Medicine Clinic in Bern is a first-class centre of excellence. This relates not only to the high professional quality of the specialists working there, but also to the technical equipment, which is of the latest generation.

The Nuclear Medicine Clinic in Bern at the Inselspital has state-of-the-art, high-end equipment at its disposal, such as PET/CTs devices and SPECT/CT devices, and works using the latest therapeutic methods in nuclear medicine. Nuclear medicine involves diagnosis and therapy using radioactive drugs (radiopharmaceuticals). It is possible to be treated at the Nuclear Medicine Clinic in Bern both as an outpatient and as an inpatient. 

Nuclear Medicine: One Subject – Many Disciplines

At the Nuclear Medicine Clinic in Bern, nuclear medicine specialists, radiopharmacists, biochemists, medical physicists and top-notch MTRA specialists work closely together – not only as it comes to carrying out examinations but also in regards to the development of procedures applied. Nuclear medicine plays an important role in diagnostic imaging. It provides relevant information and additional results that other diagnostic procedures may sometimes not be able to deliver. Nuclear medicine is thus an indispensable component completing the diagnostic picture. With the aid of radioactive isotopes (nuclides), it is possible to optimally visualise biochemical and physiological processes such as metabolism and blood circulation. At the same time, these are painless procedures largely gentle on the patient. The radiation exposure is comparable to radiological procedures. The patient is also hardly exposed to physical stress during examination and treatment. 

Prof. Rominger’s Treatment Focuses

As Clinic Director and Chief Physician at the Nuclear Medicine Clinic in Bern, Prof. Rominger has the highest level of expertise in all areas of nuclear medicine.

The highly specialised nuclear medicine physician Prof. Rominger places particular emphasis on the following diagnostic and treatment procedures:

• Diagnostics with hybrid techniques such as PET/CT and SPECT/CT in the field of oncology, neurology and cardiology
• Application of new radiopharmaceuticals together with our radiopharmacy
• Therapy of thyroid diseases using radioiodine
• Therapy of neuroendocrine tumours by means of radiopeptide therapy (PRRT)
• Therapy of prostate carcinoma metastases
• Radiosynoviorthesis in the case of diseases of the joints
• Rarer therapy methods such as radioimmunotherapy or MIBG therapy

One of the most important tasks of the Nuclear Medicine Clinic in Bern includes the medical application of radiopharmaceuticals in diagnostics, therapy, and science.

Nuclear Medicine Diagnostics

The radioactive drugs administered (radiopharmaceuticals and radiotracers) accumulate in organs and tissues in different concentrations. The distribution of deposited radiopharmaceuticals is visualised graphically as so-called scintigrams in nuclear medicine diagnostic.

Diagnostics with PET/CT and SPECT/CT

At the Nuclear Medicine Clinic in Bern, Prof. Rominger uses nuclear medicine hybrid methods combining advantages of both imaging techniques (PET plus CT or SPECT plus CT) for the benefit of the patient. This synergetic effect enables an extremely precise diagnosis and thus perfectly accurate, targeted treatment. 

While CT (computed tomography) provides high-resolution anatomical cross-sectional images of an organ or tissue, nuclear medicine examination methods such as PET (positron emission tomography) and SPECT (single-photon computed tomography) provide highly specialised additional information. These methods are thus able to identify and visualise functions such as metabolism, blood circulation, or receptor status. 

The University Clinic for Nuclear Medicine has the very latest nuclear medicine equipment at its disposal, which allows highly differentiated imaging. Thanks to this "state-of-the-art" technology, Prof. Rominger and his team are able to offer patients specialised examinations at the highest level with low radiation exposure.

Focus is placed on diagnostics in the fields of oncology (staging, restaging of tumours, especially in case of prostate carcinoma, lymphoma, lung tumours, ENT tumours, gynaecological tumours, skin tumours, tumours of the musculoskeletal system and tumours of the digestive tract and brain tumours), neurology (diagnostic clarification of dementia, movement disorders), and cardiology (heart circulation, vitality diagnostics).

Nuclear Medicine Therapy

Due to their specific accumulation mechanisms, radiopharmaceuticals can also be used therapeutically in a very targeted manner. In addition to benign and malignant thyroid diseases, the Nuclear Medicine Clinic establishes, among other things, the treatment of neuroendocrine tumours (NET) and the treatment of prostate carcinoma metastases. These nuclear medicine therapeutic options are planned on an interdisciplinary basis in close collaboration with other disciplines (including oncologists, endocrinologists, gynaecologists, surgeons, and orthopaedists) within the framework of the "University Cancer Center Inselspital" (UCI). Another focus is on joint therapy (radiosynoviorthesis, e.g., for rheumatic diseases).

Nuclear Medicine Clinic in Bern – Radioiodine Therapy of the Thyroid Gland

Another speciality of Prof. Rominger is the treatment of benign and malignant thyroid diseases. The proven nuclear medicine treatment method - known as radioiodine therapy - is not only used to combat certain forms of malignant thyroid tumours. It also serves to provide targeted treatment in case of dysfunction or enlargement of the thyroids (goitre), or for the therapy of Graves' disease. The radioactive iodine is absorbed and stored by the thyroid cells. Once entered the thyroid cells, the radiopharmaceutical releases beta radiation, which causes cell death of target tissue. In cases of pathological enlargement of the thyroid, this results in the desired degradation of hypertrophic tissues.

A big advantage of this treatment is the extreme low existence of side effects – because only thyroid cells are able to absorb the radioactive iodine. Orally ingested radioiodine, which has not been stored in the thyroid gland, is naturally excreted from the body via kidneys and urine. Healthy cells remain largely unaffected.

Radio Peptide Therapy for Neuroendocrine Tumours

Neuroendocrine tumours (NET) are rare tumours most commonly occurring in the stomach, intestinal tract or pancreas. Radiopeptide therapy of neuroendocrine tumours opens up a promising new treatment option in addition to conventional standard therapies (surgery, local treatment methods, biotherapy (sandostatin/interferon) chemotherapy). The therapy’s aim is to delay progression of tumours or metastases. A reduction of disease-related symptoms and complaints is possible as well.

Therapy for Metastatic Prostate Carcinoma

Radium-223 therapy for skeletal metastases

Prostate carcinoma is the most common type of cancer in men. In Switzerland, more than 30,000 men contracted prostate cancer in the years from 2011 to 2015. This corresponds to an incidence of 115 illnesses per 100,000 citizens. Bone metastases occur frequently over the course of the disease, and the associated pain symptoms can severely impair a person's quality of life.

In this context, nuclear medicine therapy can help maintain the quality of life through pain relief. In addition, patient studies have shown that treatment with radiopharmaceuticals can also increase survival time [Alsympca study, Parker C. et al, N Engl J Med].

The therapy is performed on an outpatient basis and usually consists of 6 therapy cycles, which are repeated at monthly intervals.

PSMA Therapy in Bern

PSMA therapy is performed for metastatic, castration-resistant prostate carcinoma. PSMA (prostate-specific membrane antigen) is a transmembrane receptor with portions on cell surfaces typically significantly overproduced on prostatic carcinoma cells. In nuclear medicine therapy, ligands of PSMA are loaded with a therapeutically radioactive metal (usually Lutetium-177) and injected into the bloodstream. From there, it is transported to all foci of the prostate carcinoma producing PSMA. The radioactive ligands subsequently dock onto the PSMAs and are subsequently transported to the interior of the prostate carcinoma cells, where they accumulate strongly. The carcinoma cells are thus locally irradiated by shrinking in about 1/3 of cases, or at least, their growth is slowed down for a certain period of time (1/3 of cases). However, in approx. 1/3 of instances, there are no satisfactory therapeutic results.

The therapeutic radiation of the PSMA ligands reaches only a few millimetres into tissue cells. Therefore, tissues surrounding the tumour are only exposed to radiation to an insignificant degree. As a result of PSMA therapy, quality of life can improve significantly, and thus life expectancy be increased. However, as with many metastatic cancers, a complete cure is usually not expected.

Whether or not a patient is eligible for PSMA therapy must first be determined by means of appropriate imaging approaches (PSMA-PET/CT). Generally, 4 - 6 therapy cycles are then carried out at intervals of 6 - 8 weeks. PSMA therapy has to take place on an inpatient basis.

The current status in Switzerland: PSMA therapy for the treatment of castration-resistant, metastatic prostate carcinoma with Lutetium-177 was approved by Swiss authorities in December 2018. Because of delivery difficulties due to producers’ licencing problems, the radiopharmaceutical is sadly not yet currently available for routine clinical practice throughout Switzerland. If this status changes in any way, we will inform here. If you have any questions, you can always confidently consult Prof. Rominger and his crew. The team consists of experts with many years of international experience in the field of PSMA diagnostics and therapy.

Radiosynoviorthesis – Nuclear Medicine for the Joints

Patients with chronic inflammatory joint disease can benefit from this nuclear medicine procedure. Although radiosynoviorthesis cannot lead to a cure, it can nevertheless significantly alleviate the pain associated with joint inflammation. 

During therapy, Prof. Rominger uses a fine needle to inject a radioactive substance directly into the affected joint. The introduced radiopharmaceutical substance spreads throughout the joint – thus the synovial membrane affected by the inflammation is irradiated. By causing a decease of inflamed tissues, Prof. Rominger initiates a regeneration of the synovial membrane. In most patients, the inflammation can thus be kept restrained for a long period of time. The significant pain reduction gives those affected back some of their quality of life. 

Nuclear Medicine Clinic in Bern – Empathy for the Patient

Thousands of patients are treated at Bern's Nuclear Medicine Clinic each year, some with serious illnesses. For Prof. Rominger, personal contact with ailing people is of particular importance.

At the University Clinic for Nuclear Medicine, the patient is at the center of joint work. He will receive highly qualified medical care based on human affection and empathy from the entire treating team, whether doctors, radiology technicians or nurses. The needs of patients of all ages, regardless of gender, nationality, world view, confession or social status, are of the highest priority. At the same time, their autonomy is respected and taken into account. Herby taken into account is the best possible status of knowledge nuclear medicine has to offer including available possibilities of individual treatment. Medical care is provided according to all facets of "best practice".

Further information can be found on Prof. Dr Axel Rominger's website.