Sex- and Age-Specific Utilization Patterns of Nuclear Medicine Procedures at a Public Tertiary Hospital in Jamaica

Abstract

Understanding the utilization patterns of nuclear medicine (NM) services is essential for optimizing resource allocation and service provision. This study aimed to address the regional evidence gap by reporting the demand for NM services by sex and age at a public hospital in Jamaica. This was a non-experimental, retrospective study of NM scans that were completed at the University Hospital of the West Indies from 1 June 2022 to 31 May 2024. While all scans were reported in the descriptive totals, for patients with multiple scans during the study period, only the data from the first visit was used in the inferential statistical analysis. This was performed with the IBM SPSS (version 29.0) software and involved the use of chi-square goodness of fit and multinomial logistic regression. A total of 1135 NM scans for 1098 patients were completed (37 patients had more than one scan); 596 (54.3%) were female and 502 (45.7%) were male, with the ages ranging from 3 days to 94 years old. Among the female patients, there was a greater demand in the ≥60 years age group for cardiac amyloid scans (χ² = 6.40, p < 0.05), while females 18–59 years had a greater demand for thyroid scans (χ² = 7.714, p < 0.05) and bone scans (χ² = 3.904, p < 0.05). On the other hand, significantly more males in the ≥60 age group presented for cardiac amyloid (χ² = 4.167; p < 0.05) and bone scans (χ² = 145.79, p < 0.01). Males were significantly less likely to undergo a thyroid scan than females (p < 0.01, OR = 0.072, 95% CI: 0.021, 0.243) while individuals aged 18–59 years were more likely to undergo this scan than patients aged 60 or older (p = 0.02, OR = 3.565, 95% CI: 1.258, 10.104). Males were more likely to do a cardiac amyloid scan (p < 0.05, OR = 2.237, 95% CI: 1.023, 4.891) but less likely to undergo a cardiac rest/stress test than females (p = 0.02, OR = 0.307, 95% CI: 0.114, 0.828). Prolonged life expectancy and an aging population have the potential to impact NM utilization, thus requiring planning for infrastructure, equipment, work force, and supplies. Cancer-related and cardiovascular indications are a top priority at this facility; hence, age- and sex-specific analysis are useful in establishing models for policy makers with regard to the allocation of economic and human resources for the sustainability of this specialized service.

1. Introduction

Non-communicable diseases (NCDs) are a major public health burden and the leading cause of death globally, and so, there is a continuous demand for active strategies to reduce the burden. The Ministry of Health and Wellness, Jamaica, has revealed that NCDs are a major public health burden and the leading cause of death among its citizens. Statistics show that an estimated 7 out of 10 Jamaicans died from either cancer, cardiovascular disease (CVD), diabetes or chronic lower respiratory disease in 2015. One of the three main strategies to reduce this burden is to strengthen the healthcare systems for people with NCDs [1]. This motivation aligns with the support from the International Atomic Energy Agency (IAEA) towards increasing access to nuclear medicine technology in the public sector of developing countries such as Jamaica, as well as ensuring sustainability [2]. Training of nuclear medicine professionals, medical equipment and national and regional projects for the continuous exchange of knowledge and expertise among different stakeholders, are a few of the key areas via which Jamaica has benefitted from this mandate.

The Nuclear Medicine (NM) Division at the University Hospital of the West Indies (UHWI) is the only one in the public sector in Jamaica, building on the foundational work of the IAEA. In line with Jamaica’s pursuit of universal health coverage, user fees were abolished for public patients in 2008, with exceptions for those with insurance coverage, private patients, and foreigners [3]. The UHWI, a quasi-governmental institution, is exempt from this policy, but does not deny care to patients who are unable to pay upfront or participate in a payment plan system to facilitate access. The NM facility, which opened its doors to the public in June 2022, complements two existing private sector facilities, thereby expanding access to nuclear medicine services for the population. Healthcare in Jamaica is more affordable in the public sector, with the cost of NM services at the UHWI being dependent on the type of procedure.

The IAEA’s project to re-establish NM services in the public-sector in Jamaica has also facilitated the establishment of a fully equipped Nuclear Pharmacy (radiopharmacy) for the compounding and dispensing of radiopharmaceuticals. Equipment provided include a biosafety cabinet, a 2-gloved shielded isolator, a radio-chromatography system and a dose calibrator. The radiopharmacy at the UHWI is the only one of its kind in the English-speaking Caribbean and relies on the importation of ⁹⁹Mo/^99mTc generators and cold kits for the compounding of radiopharmaceuticals. Professionals in various capacities have also been trained in the United Kingdom through the IAEA project, that is, two nuclear pharmacists, medical physicists, nuclear medicine technologists, and nuclear medicine physicians.

Sustainability of any NM service requires consideration of the key parameters that threaten longevity. These include, but are not limited to understanding demand and awareness of the limitation of radiopharmaceutical supplies [4,5,6]. Previous studies suggest that radiopharmaceutical demand shows sex specific differences [7], while others have shown country specific variations in radiopharmaceutical requirements, including greater demand among adults 60 years and older [8,9]. The determination of the specific needs for NM services in each country should, therefore, be explored. Jamaica, with a population of approximately 2.84 million persons, and characterized by a marginally higher proportion of females (50.55%) compared to males (49.45%), is experiencing rapid aging: a phenomenon characterized by a substantial shift in its age structure. The country’s older adult population (aged 60 and over) is growing at a rate of 1.9% per annum, underscoring the need for targeted policies and interventions to address the implications of this demographic change [10]. This study is the first of its kind in the English-speaking Caribbean to investigate age-and sex-specific utilization patterns in the demand for NM services at a public hospital, providing data critical to health planning and service sustainability.

2. Materials and Methods

This was a non-experimental, retrospective study, to include all scans completed at the NM Division at the UHWI during the period 1 June 2022 to 31 May 2024. The UHWI is a tertiary care hospital of approximately 579 beds. The hospital has 18 clinical departments, 7 non-clinical departments and other services inclusive of 24 h emergency and casualty outpatient services. The NM Division is equipped with one Siemens Symbia T6 Double-headed Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) gamma camera, Model 10275009, Siemens Medical Solutions, Hoffman Estates, IL, USA, 2018. The radiopharmacy’s operations rely on the importation of a Lantheus Medical Imaging^® TechneLite^® Technetium (Tc99m) Generator every two weeks in conjunction with pharmaceutical cold kits manufactured by Bacon Laboratories, Argentina. Patient scheduling is by an appointment-only basis, with the exception of emergency lung scan cases that may be scheduled on an expedited same-day basis. The department’s appointment schedule is dynamically managed based on the daily activity of the ⁹⁹Molybdenum/^99mTechnetium generator, which informs the operational capacity and patient throughput.

Electronically extracted data from daily records included age, sex, diagnosis upon referral for imaging, the radiopharmaceutical administered and information on the type of NM protocol performed. Ethical approval was sought and granted from the University of the West Indies Mona Campus Research Ethics Committee (Ref: CREC-MN.0207,2023/2024).

For data analysis, age was divided into four groups based on modifications to the age classifications of the Food and Drug Administration (FDA) Pediatric Drug Development Guidance Document [11]: the paediatric population was divided into <12 years (children) and 12–17 years old (adolescents) distinguishing between early growth phase and pubertal and adolescent growth and development [12]; adults were divided into 18–59 years and ≥60 years to compare the demand of adult versus elderly patients. Analyses of adult (18–59 and ≥60 years) and paediatric population (<12 and 12–17 years) were performed separately. Descriptive statistics involved the reporting by frequencies and percentages. The data was stratified by sex and the differences in observed frequencies and the expected frequencies of each age group was examined using chi-square (χ²) goodness of fit. The use of this test aligns with the study’s objectives, as it provided a robust statistical framework focused on the distributional fit of NM procedures across various sex-and age-specific demographics. Multinomial logistic regression was used to estimate the probability of scan type based on the age and sex of the patient as well as the interaction effect of both independent variables. While all scans were reported in the descriptive totals, for patients with multiple scans during the study period, only the data from the first visit was used in the inferential statistical analysis. Statistical significance was considered achieved when p < 0.05. Statistical analysis was performed with the IBM Statistical Package for Social Sciences (SPSS) software (version 29.0).

3. Results

During the two-year period between 1 June 2022 and 31 May 2024, the UHWI carried out a total of 1135 nuclear medicine scans for 1098 patients (37 patients had more than one scan). Of the total number of patients, 596 (54.3%) were female and 502 (45.7%) were male. Age data were missing for 50 patients. The age of the remaining 1048 patients ranged from 3 days to 94 years old. The mean age was 58.5 + 18.8 years: number of paediatric patients (<18 years old) was 58 (5.5%), while the adult population (≥18 years old) was 990 (94.5%) patients, of which 587 (59.3%) were in the 60 and over age group.

3.1. Trends in Radiopharmaceutical Demand by Diagnosis upon Referral and Type of Scan

Table 1. Frequency distribution of radiopharmaceuticals and diagnosis upon referral for each nuclear medicine scan.

Radiopharmaceutical	Diagnosis upon Referral	Type of Scan	Frequency (N = 1135)
99mTc-MDP			685 (60.4%)
	Prostate Cancer (281), Breast Cancer (266), Other (100), Missing (38)	Planar Bone Scan	528
		Bone SPECT/CT	154
		Triple Phase Bone Scan (±SPECT/CT)	3
99mTc-Sestamibi			150 (13.2%)
	Hyperparathyroidism (43), Hypercalcemia (11), Parathyroid Adenoma (6), Other (12) Missing (4)	Parathyroid Scan	76
	Cardiac Rest and Stress: Ischaemic Heart Disease (15), coronary artery disease (12), Other (32), Missing (26)	Cardiac Stress Test Cardiac Rest Test	49 25
99mTc-DTPA			147 (12.9%)
	Hydronephrosis (35), PUJ Obstruction (30), GFR Assessment (9), Renal Transplant Donor (9), Recurrent UTI (3), Other (37), Missing (15)	Renal Scan Renal—Captopril Study	133 1
	Gastric Emptying: Diabetes Mellitus (4), Querying Gastroparesis (1), GERD (1), PUD (1), Recurrent Vomiting (1), Other (2)	Gastric Emptying	10
	Presumed brain death (2), Obstructive Hydrocephalus (1)	Brain Death Study	3
99mTc-Pertechnetate			51 (4.5%)
	Hyperthyroidism (23), Querying Graves’s Disease (9), Hypothyroidism (4), Other (10), Missing (3)	Thyroid Scan	49
	Meckel’s Diverticulum (2)	Meckel’s Scan	2
99mTc-PYP	Querying Cardiac Amyloidosis (30), Missing (8)	Cardiac Amyloid	38 (3.3%)
99mTc-Gluceptate	Recurrent UTI (7), Hydronephrosis (4), Other (7), Missing (4)	Renal Scan	22 (1.9%)
99mTc-Nanocolloid	Malignant Melanoma (1), Breast Cancer (19)	Sentinel Node	20 (1.8%)
99mTc-MAA	Querying CTEPH (7), Querying Pulmonary Embolism (10)	Lung Perfusion Scan	17 (1.5%)
99mTc-HIDA	Hyperbilirubinemia (2), Liver laceration (1), Shared biliary tree (1), Missing (1)	Hepatobiliary Scan	5 (0.4%)

CTEPH—Chronic thromboembolic pulmonary hypertension, GERD—Gastroesophageal Reflux Disease, PUD—Peptic Ulcer Disease, PUJ—Pelvic Ureteric Junction, GFR—Glomerular filtration rate, UTI—Urinary Tract Infection.

presents the information for all scans by radiopharmaceutical used, diagnosis upon referral and type of scan required; missing data for diagnosis totalled 99 scans.

The most frequently compounded radiopharmaceutical was ^99mTc-MDP (685/1135, 60.4%) for bone scans, of which 528 (77.1%) were planar, 154 (22.5%) were bone SPECT/CT and 3 (0.4%) were triple-phase (+SPECT/CT). ^99mTc-Sestamibi (150/1135, 13.2%) was the second most frequently compounded radiopharmaceutical for parathyroid (76, 50.6%), cardiac stress test (49, 32.7%) and cardiac rest tests (25, 16.7%). This was followed by ^99mTc-DTPA (147/1135, 12.9%) for renal, (134, 91%) gastric emptying (10, 7%) and brain death scans (3, 2%).

Of the total number of bone scans, diagnosis upon presentation were primarily prostate cancer (281/685, 41%) and breast cancer (266, 39%). Other cancer-related diagnoses accounted for 74 (10.8%) of the bone scans, while non-cancer related diagnoses totalled 26 (3.8%) scans. Among the diagnosis for patients who were referred for parathyroid scans were hyperparathyroidism (43/76, 57%) and hypercalcemia (11, 14.5%), while the most frequently presented diagnosis for myocardial perfusion imaging were ischaemic heart disease (15/74, 20.3%) and coronary artery disease (12, 16.2%). Unstable angina (6), congestive cardiac failure (3) and dilated cardiomyopathy (2) were other referred diagnosis for cardiac rest/stress scans. Diagnosis for renal scans included hydronephrosis (35/134, 22%) and pelvic ureteric junction obstruction (30, 19%).

Table 2. Demographic data of patients with multiple scans during the study period.

Age (Years)	Number of Patients (N = 37)
<12	1
18–59	11
≥60	25
Sex
Males	17
Females	20
Type of Scan
Bone	11
Cardiac rest and stress tests	13
Renal	5
Parathyroid	3
Bone and cardiac amyloidosis	1
Bone and cardiac stress test	1
Bone and sentinel node	1
Bone and thyroid	1
Bone and renal	1

shows information for 37 patients who utilized the NM services more than once during the study period, by age, sex and type of scan. For these patients, only the data from their first visit was used in the inferential statistical analysis.

3.2. Trends in Nuclear Scan Demand by Age and Sex—Adult Population

There were a total of 1026 scans for 990 patients with age recorded in the adult population of 18 years and older. There were 403 (40.7%) patients in the 18–59 age range and 587 (59.3%) patients in the 60 and older age range. Among this population, 545 (55.1%) were females and 445 (44.9%) were males. The data was stratified by sex and analyzed using chi-square goodness of fit. Among the female patients, there was a greater demand in the 60 and over age group for cardiac amyloid scans (χ² = 6.40, p < 0.05), while females 18–59 years had a greater demand for thyroid scans (χ² = 7.714, p < 0.05) and bone scans (χ² = 3.904, p < 0.05) (Figure 1A). Significantly more male patients in the 60 and over age group presented for bone scans (χ² = 145.79, p < 0.01) and for cardiac amyloid scans (χ² = 4.167; p < 0.05) (Figure 1B).

Multinomial logistic regression analysis was used to examine the relationship between age, sex and the type of nuclear scan performed. The results highlighted several significant associations between the demographic variables age and sex and the dependent variable, type of scan. These are indicated by p-values less than 0.05, which are circled in red (

Table 3. Multinomial Logistic Regression Analysis of Nuclear Scan Type by Age and Sex.

Dependent Variable	Independent Variable	B (Coefficient)	Exp(B) (Odds Ratio)	95% CI Odds Ratio	p (Sig.)
Cardiac Amyloid Scan	Male	0.805	2.237	1.023, 4.891	<0.05
	Female	Reference Group
	Age 18–59	−0.366	0.693	0.299, 1.607	0.393
	Age ≥ 60	Reference Group
Cardiac Rest/Stress	Male	−1.180	0.307	0.114, 0.828	0.02
	Female	Reference Group
	Age 18–59	0.094	1.098	0.381, 3.167	0.863
	Age ≥ 60	Reference Group
Parathyroid Scan	Male	−1.941	0.144	0.055, 0.375	<0.01
	Female	Reference Group
	Age 18–59	0.486	1.626	0.621, 4.259	0.323
	Age ≥ 60	Reference Group
Renal Scan	Male	−0.690	0.502	0.211, 1.192	0.118
	Female	Reference Group
	Age 18–59	1.268	3.553	1.423, 80871	<0.01
	Age ≥ 60	Reference Group
Thyroid Scan	Male	−2.631	0.072	0.021, 0.243	<0.01
	Female	Reference Group
	Age 18–59	1.271	3.565	1.258, 10.104	0.02
	Age ≥ 60	Reference Group

Model χ² = 98.720, p ≤ 0.001. Nagelkerke R² = 0.103. N = 990.

). Males were significantly less likely to undergo a thyroid scan than females (p < 0.01), with an odds ratio (OR) of 0.072 (95% Confidence interval (CI): 0.021, 0.243). Additionally, individuals aged 18–59 years were significantly more likely to undergo this scan than patients aged 60 or older (p = 0.02, OR = 3.565, 95% CI: 1.258, 10.104). Males were more likely to do a cardiac amyloid scan (p < 0.05, OR = 2.237, 95% CI: 1.023, 4.891) but less likely to undergo a cardiac rest/stress test than females (p = 0.02, OR = 0.307, 95% CI: 0.114, 0.828). The likelihood ratio test provided evidence that the interaction between sex and age is a significant predictor of the type of scan completed (χ² = 46.795, df = 10, p = 0.01), indicating that the effect of age on the type of scan varies across both sexes.

3.3. Trends in Nuclear Scan Demand by Age and Sex—Paediatric Population

During the study period, a total of 59 scans for 58 patients with age recorded to be under 18 years was completed. Of this number, 41 (70.7%) were under the age of 12, and 17 (29.3%) were between the age of 12 and 17 years. Forty-three (43, 74.1%) patients in this population were males while 15 (25.9%) were females. Among the female paediatric patients, all of the hepatobiliary scans (3, 100%) were for patients in the under 12 age range (Figure 2A), while among male patients, renal-Gluceptate scans (17, 100%), Meckel’s diverticulum (2, 100%) and gastric emptying scans (3, 75%) were completed for children in the under 12 age group (Figure 2B). Inferential statistical analysis revealed no significant difference in proportions between the paediatric groups.

4. Discussion

The provision of adequate diagnostic services to assist countries such as Jamaica in achieving its 2030 sustainable development goals is vital [10]. This study is the first to investigate the demand for NM services in a public hospital in Jamaica, as well as the differences in this demand by age and sex. The greatest demand for the NM services were a diagnostic need related to cancer and CVDs. This aligns with a previous study, which revealed that greater than 90% of NM procedures that were performed in Latin America and the Caribbean between 2014 and 2020 were diagnostic, with bone, cardiac and renal scintigraphy being the most common [13]. With NCDs accounting for 47% of all deaths in the Americas [14], an understanding and appreciation for NM as a fundamental tool for patient-specific diagnosis and treatment is crucial in the ongoing battle to reduce the prevalence of NCDs [13]. This study has revealed that 56% (587/1048) of the patient population utilizing this NM service were in the 60 and over age group. The proportion of older adults in the study population may be reflective of the global phenomenon of population aging, which requires adaptation to minimize social, economic and healthcare consequences, including the potential inability to meet the demand for NM services as a diagnostic tool [4,8,15].

4.1. Cancer

Generally, bone scans using ^99mTc-MDP for metastatic breast and prostate cancer were the most widely utilized NM procedure by both sexes at this facility. Similar results were obtained in a previous study that was conducted at a privately run NM facility in Jamaica for the two-year period of 2017–2018 [16], and they are consistent with statistics that were reported by the IAEA in a 3-year assessment of 99 developing countries in Africa, Latin America and the Caribbean, Asia, Middle East, Eastern Europe and Northern Asia from 2008 to 2010 [17]. The highest rates of prostate cancer diagnosis have been noted in Northern Europe, Australia/New Zealand, the Caribbean and North America, with the highest mortality rates in the Caribbean and sub-Saharan Africa [18]. Ramesar et al. in their examination of prostate cancer in the Caribbean have revealed that the countries with diminished resources have a greater incidence of advanced illnesses and poorer outcomes [19]. Jamaica, with a population of approximately 3 million has an average of 1.07 gamma cameras per million population, compared to other upper-middle-income countries in the Latin America and Caribbean Region such as Argentina and Brazil, with 8.74 and 6.36 gamma cameras per million, respectively [13]. The UHWI is the only facility on the island that provides whole-body bone-SPECT scintigraphy as well as the hybrid SPECT/CT bone imaging. The fusion of SPECT and CT has been shown to improve diagnosis and patient management, as it assesses both functional and morphological changes, resulting in more accurate detection of bone metastases [20].

4.2. Cardiac

Another common diagnostic NM procedure involved the use of ^99mTc-Sestamibi. The demand for this radiopharmaceutical for myocardial perfusion imaging (cardiac rest and stress test) represents one of the diagnostic scans related to cardiovascular diseases. ^99mTc-Pyrophosphate use for cardiac amyloid scans were also in demand and had a significantly higher number of older adults from both sexes (females, p = 0.01, males, p < 0.05) utilizing the service. While the cardiovascular applications of NM procedures rank among the most widely performed scans in the United States of America, this was found not to be the case in developing countries [17]. The IAEA in its role to support countries in addressing health needs has provided assistance in the establishment and progression of the use of nuclear cardiology in the management of patients with CVD [21]. The UHWI is currently the only facility in the public sector in Jamaica that provides myocardial perfusion imaging (MPI) and the only facility in the country that offers cardiac amyloid scans. This study has revealed that while men are more likely to undergo a cardiac amyloid scan, women are more likely to undergo a cardiac rest/stress test. While the choice of test is dependent on the suspected underlying conditions, factors such as patient demographics and healthcare provider recommendations may play a role in testing patterns. The greater representation among older adults is consistent with a report from a 2022 systematic review [22], and the prevailing literature suggesting risk disparities by sex among Caribbean women [21,23] supports the demand observed at this facility. CVD is responsible for approximately 8.4 million deaths among women each year, that is, 35% of all female deaths worldwide [23]. The higher disease prevalence among women may be due to contributing factors such as obesity, vasospastic disorders, prolonged immobilization and increased longevity in women compared to men [24]. In this study, 62% of the patients for myocardial perfusion imaging were females. This overrepresentation by women requires further investigation to determine if greater healthcare utilization or gendered referral patterns or diagnostic biases play a role.

4.3. Thyroid

Sex-based differences do impact medicine and, therefore, should be a consideration in the management of certain disorders. This becomes an important factor in nuclear medicine applications that are geared towards individualized interventions [7]. One such condition is thyroid disease, for which a risk factor for its development is the female sex, [25] and it has a higher global prevalence in women compared to men [25,26]. Allahabadia et al. in their study of 536 patients with Graves’ hyperthyroidism, of which 444 were females and 92 were males, concluded that sex and age are factors that should be taken into consideration in the management of such a disease [27]. These trends are consistent with the greater diagnostic demand for thyroid scans among adult females [28]. In this study, 88% (43/49) of the patients who presented for thyroid scans were females, with 65.3% (32/49) of the patients being between the ages of 18 and 59 years and 32.7% (16/49) being 60 years and over. Additionally, the data has revealed that women are more likely to undergo a thyroid scan and so are patients in the 18–59 age range. These findings may spark the development of targeted outreach programs to encourage patients outside of these demographics to increase uptake, highlighting the benefits of early detection and treatment of associated disorders. Partnerships and collaborations with other healthcare providers or organizations to improve access for underrepresented groups may also advance the effectiveness of the service.

4.4. Pediatric Population

Among the paediatric population, the most utilized NM service was renal scans for nephro-urological conditions among more males than females. This is the norm for paediatric NM facilities and is largely as a result of the increased incidence of urinary tract infections, hydronephrosis and other renally acquired conditions among children [29].

4.5. Implications for Health System Policies and Sustainability

Overall, this newly commissioned NM facility performed approximately 600 scans per year for the first two years of operations. Similarly, another developing country, Nigeria, with two available gamma cameras within the public sector serving a population of approximately 170 million people, also reported performing between 600 and 700 studies per annum [30]. With only one SPECT/CT gamma camera within the public healthcare system in Jamaica, this reflects a low-volume facility with the potential for greater utilization and growth.

Predicting the age and sex of patients who use the service can significantly impact health system policy. The results of the study demonstrate that the incidences of diseases that are diagnosed or treated with nuclear medicine vary between different age groups and sexes, and so a forecast of the demand based on patient demographics facilitates proper radiopharmaceutical procurement and inventory management. The optimization of procedures for the ordering, compounding and administration of these compounds, coupled with waste reduction, influence resource allocation and planning. Recognizing age and sex-based differences may also reveal potential disparities in healthcare access or utilization. Policies aimed at equitable access may address and improve identified gaps in care. This approach is geared at empowering the health system to deviate from generic strategies to providing a more tailored or individualized healthcare delivery system.

The data from the study may be useful in establishing models for policy makers with regard to the allocation of economic and human resources for the sustainability of the service in the public sector. While the institution may develop evidence-based forecasting models for equipment and radiopharmaceutical procurement, continued collaborations with the IAEA for capacity building may involve continued education and training to improve the skills and knowledge of NM professionals. Additionally, the allocation of resources for multifunctional and hybrid instrumentation as well as complementary resources and systems for the enhancement of the range and quality of services offered, may be beneficial to practitioners in their diagnostic and therapeutic algorithms.

This study has several limitations. Firstly, the reliance on manual data entry into the computer software by administrative personnel resulted in missing data from patient diagnosis on referral, as well as the ages of a number of patients. Furthermore, the lack of automated data validation and verification processes precluded the ability to confirm the accuracy of the entered data, potentially introducing errors and biases into the dataset. Secondly, due to the single-site design of the study, which was conducted at an urban hospital, there is the potential lack of generalizability to other settings or populations across the country. Thirdly, the absence of socioeconomic and comorbidity information represents a notable limitation. This omission may have resulted in an incomplete understanding of the relationships between patient demographics and service utilization, thereby creating a potential bias of the findings. The lack of clinical outcome data may have also limited the study’s ability to assess the impact of NM services on patient- centered outcomes.

Despite these limitations, the study provides an initial framework of age-and sex-specific demand for NM applications at the only public-sector facility in the country. Interventions include the following:

• The widespread sensitization of clinicians on the value that NM techniques may add to patient management;
• Mitigation of the challenges associated with the financial burden on NM patients;
• Fewer hiccups during the importation and customs clearance of molybdenum-99^/99mTc generators;
• Reduced down-time of equipment by increased access to service and maintenance providers;
• The strengthening of human resources by acquiring an increased number of trained NM professionals may all lead to enhanced utilization and more effective and equitable service delivery.

Future studies would benefit from incorporating important variables such as socioeconomic, comorbidity and clinical outcome data to provide a more comprehensive understanding of the impact of the service.

5. Conclusions

This study’s findings on the demographic characteristics of patients utilizing NM services at the UHWI have significant implications for the sustainability of the facility. Overall healthcare utilization may be influenced by factors such as the need for care, enabling or inhibiting factors such as socio-economic status and availability of medical care, as well as predisposing factors such as sex and age [8]. As Jamaica’s population continues to age, understanding the age and sex distribution of patients accessing NM services will be crucial for informing resource allocation, service planning and policy development. With the limited resources of developing countries, sustainability of the services will need continued analysis of the demands and their value to reducing disease burden. The insights gained from this study can contribute to ensuring the long-term viability and effectiveness of NM services in Jamaica, ultimately enhancing the health outcomes of the population.