Lung cancer: CT screening only for heavy smokers

S & T

April 25, 2012 

 Lung cancer: CT screening only for heavy smokers

The Hindu CAUTION ADVISED: Low-dose CT screening produces large false-positive results. Photo: K.R. Deepak 

Low dose CT screening for lung cancer is recommended only for 55-74-year-olds who have smoked a pack daily for 30 years
 

On April 23, 2012, the American Lung Association (ALA) released its interim guidance recommending low dose computed tomography (CT) screening for diagnosing lung cancer among smokers. The recommendation is based on the first report of the ALA lung cancer screening committee, chaired by Dr. Jonathen Samet from the University of Southern California.

The recommendation

ALA recommends screening only for a limited group. These are current or former smokers, aged 55 to 74 years with a smoking history of at least 30 pack-years and no history of lung cancer.

Smoking history of 30 pack years means smoking a pack of cigarettes daily for thirty years or two packs daily for 15 years etc.

ALA notes that while CT screening for lung cancer may save lives, it should not be recommended for everyone due to many known and unknown risks that may be associated with the screening and subsequent medical evaluation and follow-up. Radiation risk is one of them.

In spite of this caution, Auntminnie.com, a trade journal, stated that the move is a major step toward the development of a population-based CT screening programme in the U.S.

The U.S. National Cancer Institute's National Lung Screening Trial (NLST), found that low-dose CT can reduce mortality by at least 20 percent compared to chest x-ray, and other reports have pushed the estimated mortality gains even higher. The ALA guidelines followed the results of NLST of smokers at-risk, released in November 2010.

Even in this high risk group, 320 persons had to be screened with CT to prevent one lung cancer death.

The benefit of CT screening for lung cancer cannot be easily estimated for populations with risk profiles that are different from those of the NLST participants.

Can cause cancer

According to Centers for Disease Control and Prevention, screening with CT scans is not risk-free. Radiation exposure from repeated CT scans is cumulative and can lead to cancer.

Average effective radiation dose in “low dose” CT in NLST was 1.5 mSv as against 7 mSv in a full diagnostic helical CT.

Specialists have criticised low-dose CT screening due to the large number (as high as 25 per cent) of false-positive results, meaning that the positive finding did not prove to be lung cancer following diagnostic investigations. People who receive false-positive results may be subjected to unnecessary testing, including more radiation exposure, invasive diagnostic and surgical procedures, complications, and even death, diminishing the benefit of early cancer detection.

Over-diagnosis due to screening must have revealed indolent cancers which may never progress into full blown cancer. They may end up undergoing an invasive intervention that they would not otherwise need.

According to ALA, individuals should not receive a chest X-ray for lung cancer screening as it has low sensitivity.

ALA Committee suggested that ALA should ask hospitals and screening centres to: establish ethical policies for advertising and promoting lung cancer CT screening services; develop educational materials to assist patients in having careful and thoughtful discussions between patients and their physicians regarding lung cancer screening and to provide lung cancer screening services with access to multidisciplinary teams that can deliver the needed follow-up for evaluation of nodules.

Smoking, major cause

Lung cancer is a fatal disease. Currently, specialists believe that smoking causes up to 80-90 per cent of lung cancer cases.

The significance of the guidance is evident as the five-year survival rate for lung cancer presently stands at 15.6 percent as compared to an over 90 percent survival rate for breast, colon and prostate cancers.

ALA recommendation may lead to many undesirable developments. Hospitals may start direct-to-consumer advertising to recruit patients who might have resources to pay out-of pocket for low-dose CT screening.. “…the promotion of such services should not prey upon the public's fear of lung cancer while leading them to believe that low-dose CT screening will eliminate all risk from lung cancer,” ALA warned.

“Unfortunately, even before the NLST results were released, CT screening for lung cancer was being offered by some institutions and subsequent to the release an increasing number of well-respected medical centres throughout the country are offering lung cancer screening to their constituents at markedly reduced prices.” ALA observed.

Public cautioned

“Never starting smoking and quitting smoking still remains the best way to prevent lung cancer”, Dr Norman H. Edelman, Chief Medical Officer, American Lung Association cautioned the public.

Individuals have to take their own decisions on screening based on inputs from all

reputable sources. Do not trust advertisements glorifying CT screening.

K.S. PARTHASARATHY , Former Secretary, Atomic Energy Regulatory Board

(ksparth@yahoo.co.uk)  Keywords: computed tomography, lung cancer screening

Nuclear renaissance may continue

Nuclear renaissance may continue

Travails of medical imaging of bulky patients

Travails in medical imaging of bulky patients

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The constraint: Some obese patients are too large to image using even X-ray films of large size. They need multiple cassettes. Photo: AFP

Keen observation and analysis of case sheets of patients proved rewarding for Dr Raul Uppot, a young radiologist at the Massachusetts General Hospital (MGH), in Boston, U.S. He realised that a tiny fraction of patients are denied medical imaging facilities simply because they are bulky. Radiologists could not provide optimum image quality and accurate diagnoses in their cases.

Dr. Uppot and his co-workers reviewed the radiology reports filed between 1989 and 2003 labelled as “limited by body habitus” meaning limited in quality due to the patient's size. They found that over the 15-year period, the percentage of such reports nearly doubled from 0.10 in 1989 to 0.19 in 2003. It correlated strongly with the increase in obesity in Massachusetts State from 9 per cent in 1991 to 16 per cent in 2001.

He presented the study at the annual meeting of the Radiological Society of North America (RSNA-2004). RSNA appreciated his paper and awarded him the 2004 Research Fellow Trainee Prize of $ 1,000.

Dr Uppot observed that in the 15-year-old retrospective study of radiological exams at MGH, the diagnostic information of 0.15 per cent of the five million studies was limited by the body weight of patients. They did not include patients whose examinations were cancelled because they could not fit on the table.

Obesity adversely impacts on simple x-ray and other life saving procedures such as CT scans, ultrasound and magnetic resonance imaging (MRI).

The issue was so important that the RSNA held a special focus session on “Obesity: The Impact on Radiology” during its Annual convention (RSNA 2005) at Chicago. It continues to be important.

In a recent review in Vascular Medicine (December 2011) Philip C. Hawley of the Grant Medical Centre, Columbus and Miles P. Hawley, The Ohio State University Medical Center, Columbus, recommended further research on both imaging and outcomes in the area.

In Radiology Rounds, a newsletter for Referring Physicians, published by Massachusetts General Hospital, Janet Cochrane Miller noted that fat affects ultrasound images to a greater degree than any other medical imaging modality. At the frequency range normally used (3 to 7 MHz) for abdominal imaging, one cm of fat attenuates 50 per cent of the beam intensity. At lower frequencies attenuation is less; image resolution is also less.

Miller estimated that 20 patients in 1,000 may not get the benefit of ultrasound scans because of excess body weight. Corresponding data for MRI scan is one in 1,000; abdominal CT: 4 in 1,000; chest x-ray: 5 in 1,000.

Some obese patients are too large to image using even x-ray films of large size. They need multiple cassettes. “When they exceed the weight limit for x-ray tables, patients can sometimes be imaged while standing”, Miller wrote.

To a question whether he expects that the issues he raised in the U.S. will be applicable to India, Dr Uppot who is currently assistant professor, Harvard Medical School, clarified that the issues start with ultrasound imaging at 250 pounds.

“Census data in India may need to identify the percentage of Indians who reach more than 250 pounds”, he added.

Relevance to India

“Has he got any suggestions for the Indian medical community? “The Indian medical community should be aware of the issue. In India, as in other Asian and European countries there is great reliance of ultrasound for medical imaging.

Of all the imaging modalities, ultrasound is the most sensitive to obesity. Indians who have excessive subcutaneous fat will present challenges to physicians who rely on ultrasound to make diagnosis”.

To the query on improvements in producing optimal images of obese patients, Dr Uppot stated that “manufacturers of imaging equipment have tried to address the issue by: (1) Increasing weight limits and gantry/bore diameters of their equipment so that patients can fit. (2) Used technology to improve the image quality such as harmonic imaging for ultrasound and (3) and used technology to try to decrease the increased radiation doses for CT in obese patients”.

The Lancet (November 20, 2010) reported that currently in India, almost 1 in 5 men and over 1 in 6 women are overweight. In some urban areas, the rates are as high as 40 per cent. But I do not know of any Indian publication on the difficulties of imaging obese patients.

The medical community in India must appreciate the issues and be prepared to face the challenges of imaging overweight patients

K.S. PARTHASARATHY

Raja Ramanana fellow, Department of Atomic Energy

(ksparth@yahoo.co.uk)

Keywords: medical imaging, bulky patients

Why nuclear power is not the dream that failed?

On March 10, 2012, The Economist magazine published an article titled " Nuclear power: the dream that failed". The article was one sided and ignored many developments which may prove to be a game changer. For instance, Republic of Korea entered into a contract with UAE to construct four nuclear power reactors in UAE. Some specialists observed that Korea may complete the project on time and within budget, Korea has beaten French industry which is currently recalibrating its approach to commercial nuclear power. 

 You can access the article at:
http://www.rediff.com/news/slide-show/slide-show-1-why-nuclear-power-is-not-the-dream-that-failed/20120321.htm

My articles: Is the edifice of radiation protection built on a lie?

My articles: Is the edifice of radiation protection built on a lie?

Is the edifice of radiation protection built on a lie?

S & T

Published: January 26, 2012 01:39 IST | Updated: January 26, 2012 01:39 IST

Is the edifice of radiation protection built on a lie?

The Linear No Threshold concept assumes that the risk from radiation exposure varies linearly with total dose with no threshold

Recently, Edward Calabrese, an environmental toxicologist at the University of Amherst found out that Dr Hermann J. Muller, famous radiation geneticist knowingly lied in his Nobel Prize lecture when he claimed that there was “no escape from the conclusion that there is no threshold.” Calabrese described his discovery in September in Archives of Toxicology and Environmental and Molecular Mutagenesis

In 1927, Muller discovered that x-ray irradiation produces mutations in male fruit-fly germ cells. For this, he received the Nobel Prize in Physiology or Medicine in 1946. Many believe that Muller's assertion became a corner stone of radiation protection. This is the Linear No Threshold (LNT) concept which assumes that the risk from radiation exposure varies linearly with total dose with no threshold and any dose however small has an adverse effect.

Expert bodies accepted this model because of its simplicity in the management of radiation protection programmes.

“However, it has done much damage to speak of ‘no safe level of radiation' in scaring not only the public, but also those professionally involved in peacetime health physics who have not been involved in high levels and emergency situations,” Allen Brodsky, Adjunct Professor of Radiation Science, Georgetown University responded to an e-mail query.

In response to an e-mail query Calabrese disclosed that a reviewer of his article on the history of dose-response argued that he had not done a good job on the Muller section and key early radiation mutation studies. Calabrese found that a paper from the University of Rochester by Curt Stern and Casper on fruit-fly irradiation and germ cell mutation was published in 1948 but it was actually completed in August of 1946.

“This study was very important because it did not support a linear dose response and because it was the strongest study to date...using the lowest dose rate etc. I knew that Muller gave his Nobel Prize lecture on Dec. 12, 1946. So the question was whether Muller was aware of the new findings before his major speech,” Calabrese replied

By reviewing Stern's correspondence with Muller, Calabrese established that Muller knew of the findings which contradicted his theory a month prior to the Nobel Lecture.

Calabrese asserts that Muller's passionate beliefs influenced the way government and society viewed the risks of low doses of radiation. The 1956 recommendations of the US National Academy of Sciences (NAS) BEAR (Biological Effects of Atomic Radiation) I Committee reflected these views. Regulating ionizing radiation as if there was no safe dose began!

James Schwartz, a biographer of Muller, Kenneth Muller, Hermann Muller's grandson and Elof Axel Carlson, Muller's former student do not agree with Calabrese. Some feel that Calabrese, a supporter of radiation hormesis (beneficial effect) has conflict of interest. The balance of evidence shows that the edifice of radiation protection is not built on a lie.

Dr Evan B. Douple, Associate Chief of Research at the Radiation Effects Research Foundation, Hiroshima, does not think that the LNT hypothesis would have lost its applicability if Professor Muller would not have made the passionate statement in his speech.

“……. by the time the BEIR (Biological Effects of Ionizing Radiation) committees of the National Academy of Sciences began updating the risk estimates, the mutation risk was superseded by the risk of cancer. Having been intimately involved with the BEIR VI and BEIR VII studies, I can assure you that the voluminous data reviewed by the committee members that related to supporting or refuting LNT, was not swayed or overly influenced by the shape of a dose-response curve in the mutation work of Muller,” Douple responded. (Dr Douple was Director, Board on Radiation Effects Research, National Research Council)

He is not even sure that Calabrese's interpretation and assessment that Muller was deceptive in his presentation is necessarily accurate or fair.

“Although somatic mutations became a dogma for radiation carcinogenesis, the LNT for carcinogenesis was based on (a) analyses of cancer induction in rodent models, (b) biophysical characteristics of energy deposition, ionizations, and DNA damage in cells, and (c) the early epidemiological studies of cancer in the Japan A-bomb survivors,” he clarified in an e-mail.

He does not think that the conjecture and personal interpretation of an untestable accusation will have significant impact among the radiation protection community.

Prof Ludwig E. Feinendegen, Heinrich-Heine University, Germany thought that “the new revelations on low-dose effects in the realm of biological responses are making an impact on the radiation protection community — as it appears currently from the defensive manner of their arguments for keeping the LNT model, at least for the time being. Calabrese has done us a great favour by his new paper on Mueller's mistake.”

That there is no safe level of radiation continues to be a useful assumption in radiation protection. It is yet to be proved as a scientific fact.

Douple believes that the exhaustive efforts of those who claim that demonstrating hormesis (beneficial effect) or the presence of thresholds will revolutionize the radiation protection field are misguided.

“We need to educate the public regarding the importance of ‘acceptable levels of risk'—levels that are believed to include risks, but risks for adverse effects that are so small that one would not be able to observe and measure an excess of the effects with a realistic study. Only then will the fear and paranoia associated with radiation effects gradually become less and less and sources for energy production can be fairly and objectively be evaluated,” Douple proposed as a realistic way forward.

Regulators want dose limits for enforcing radiation protection. What is the threshold dose value they will accept for enforcement? Calabrese and his followers have not yet responded to my query.

The French Academy of Sciences, the only scholarly body which has views closer to those of Calabrese on hormesis conceded that on the basis of present knowledge, it is not possible to define the threshold level (between 5 and 50 mSv) or to provide the evidence for it. The dose limit for workers recommended by the International Commission on Radiological Protection (ICRP) is 20 mSv per year averaged over five years with no year exceeding 50 mSv. The dose levels to radiation workers achievable are so low that the risk from them is negligible. Negligible risk is no risk at all. That we cannot rule out beneficial effects of radiation is also a comforting thought.

K.S. Parthasarathy

Raja Ramanna Fellow, Department of Atomic Energy (ksparth@yahoo.co.uk)

Keywords: radiation exposure

www.indoeuropean.in

Printable version | Jan 26, 2012 8:32:36 AM | http://www.thehindu.com/sci-tech/article2831847.ece

© The Hindu

Anti nuclear activists are lying or are ignorant

With malice towards none, and knowledge for all!

Those keen to sift facts from fiction may read the following note:

There is widespread wrong information about the status of nuclear power in USA after 1979, the year in which the accident occurred at the Three Mile Island nuclear power station.

Many anti nuclear activists state that since 1977, USA has not built any new nuclear power plant. There is a little confusion here. It is true that USA has not issued any new licence to construct a nuclear power plant. Government approved  up-rating the power of existing reactors by 6000MW from 1977 to 2011. From 2011 to 2015, 3211 MWe will be added.

Electric companies connected 50 out of the 104 currently operating nuclear power plants in USA to the grid after 1979, the year in which the Three Mile Island accident occurred. Nineteen of them after 1986, the year in which the Chernobyl accident occurred. Fifty three out of the 59 French reactors came on line after 1979.

The net capacity factor  of a power plant is the ratio of the actual output of a power plant over a period of time and its potential output if it had operated at full  capacity the entire time.

The capacity factor of nuclear power reactors in USA averaged about 57 % in 1980. It increased gradually. From 2004 till 2010 (the latest data)it averaged over 90%. Twenty two US nuclear power reactors out of the 104 exceeded  a capacity factor of 100%. In 2010 the capacity factors of other modes of power generation in % were: Biomass 85.5;.Geothermal 71.6;Coal (Steam turbine) 65.4;Gas(Combined cycle) 45.8;Hydro 29.4; Wind 29.1;Solar 17.7;Gas (Steam turbine) 12.9; oil (steam turbine) 8.9

Anti-nuclear critics claim that Russia stopped constructing nuclear power after 1986, the year in which the accident occurred at the Chernobyl nuclear power station.

What is the factual position?

 Russian power utilities started commercial operation of eight nuclear power reactors after 1986 . One of them in May 1986 a month after the Chernobyl accident. The last one of 950 Mgawatt became critical on November 11, 2011 and is operating at 50% power as one December 13, 2011.

Russia currently has an installed nuclear power capacity of 24,164 MWe from 33 reactors. It has started construction and  planned and proposed to erect 53 nuclear power reactors with a total capacity of over 50,000 MWe

China operates 15 reactors with a total capacity of 11,881 MWe starting from 1994. Nuclear power reactors under construction and  planned number 77 with a total capacity of 85,750MW.

Additional reactors are planned, including some of the world's most advanced, to give a five- or six-fold increase in nuclear capacity to at least 60 GWe by 2020, then 200 GWe by 2030, and 400 GWe by 2050. 

Until March 2011, Germany generated 25% of its electricity from nuclear energy using 17 reactors.In 1998, Germany decided to phase out nuclear power; in 2009 Government cancelled this policy but shut down eight reactors post Fukushima even before the factual position about the accident was known.

 French and Czechs are happy going to their banks. To compensate for the power generated by the seven reactors, Germany imports power from France and Czech Republic. France’s share of export to Germany increased by 50% in the first half of the year; Czech’s share went up by a whopping 673%(The Sydney Herald, November 26, 2011)

According to the paper, at peak times, up to four nuclear power stations in France and the Czech Republic are running just to cater to the demands of Germany

Kudankulam Reactors: Nuclear myths

PTI FEATURE

VOL NO XXVII(46)- 2011                                    November 12, 2011

           

                                                                                              SCIENCE & TECHNOLOGY

                                                                      PF-183/2011

Kudankulam Reactors: Nuclear Myths

By Dr K S Parthaarathy

Recently, an energy specialist showed that under realistic assumptions, India will not be able to maintain a modest  annual per capita power need of about 2000 kWh by 2070 by  renewable energy alone; the maximum potential for renewable will be 36.1%. (Current Science, Sept 10, 2011), Fossil fuel and nuclear will continue to play their role. He believes that hundred years later, India has to depend on nuclear power only.

Recently anti nuclear activists scored over staunch nuclear power proponents by planning a fast of infants against Kudankulam project! Infants cannot protest; parents forced them to fast. Mercifully it was only for one hour. I do not know whether it is legal or whether it may be considered as child abuse. It was a clever ploy to get publicity. Next, the activists may argue that reactors will kill babies and babies’ babies!

Misinformation, misconcepts and other issues are coming in the way of commissioning the first Generation 3+ advanced nuclear power reactor in India.

In an article titled “India: People power vs. nuclear power (The Daily Star, October 17, 2011), Praful Bidwai claimed that  Kudankulam reactors will daily draw in millions of litre of freshwater, and release it at a high temperature into the sea, affecting the fish catch on which lakhs of livelihoods depend.

The reactors will not use fresh water but water from a desalination plant erected at site. The temperature of water from the reactors discharged in to the sea will be in compliance with the stipulations of the Ministry of Environment and Forests (MOEF), Government of India. This discharge will not affect fish catch nor will it adversely affect marine ecology.

Bidwai’s observation that the reactors are being built within a one-kilometre radius of major population-centres, violating the 1.6-km "nil-population" zone stipulation is not true.

Nuclear Power Corporation India Limited (NPCIL) keeps an area of 1.5 kilo-metre radius

around the reactors under its exclusive control as required by the Atomic Energy Regulatory Board (AERB) Code on Safety in Nuclear Power Plant Siting. The site satisfies other AERB stipulations.AERB allows the reactors to release effluents and emissions routinely. NPCIL ensures that the limits for releases prescribed by the Atomic Energy Regulatory Board (AERB) are not exceeded.

Bidwai scares people by describing radioactivity as “a regular poison you can’t see, touch or smell”. He knows that these shortcomings have not come in the way of using radiation in medical, industrial and research applications. That we can measure radioactivity and radiation accurately at extremely low levels helps to enforce regulatory limits on releases and emissions.

Bidwai notes that scientific studies covering 136 nuclear sites in seven countries showed some adverse health effects. The reference is to a paper by Baker and Hoel in the European Journal of Cancer Care (2007). It offered some evidence of elevated leukemia rates among children living near nuclear facilities. The authors described the limitations of the study and also referred to studies which did not show any effect. They referred to studies in which leukemia effect was seen before the nuclear facilities started operation!

 Specialists criticized the study for its methodological weaknesses, such as combining heterogeneous data (different age groups, sites that were not nuclear power plants, different zone definitions), arbitrary selection of 17 out of 37 individual studies, exclusion of sites with zero observed cases or deaths, etc (Wikipedia).

Though the paper deals with leukemia only and no other effects, Bidwai claimed that the study shows “abnormally high leukemia rates among children and higher incidence of cancers, congenital deformities, and immunity and organ damage”. Nuclear critics have a way of shaming epidemiologists and other specialists by cherry picking data and inventing conclusions!

 

 The Chernobyl accident caused two deaths immediately and 28 deaths within a few months. According to the United Nations Scientific Committee on the Effects of Atomic Radiation (2011), there were 15 more deaths due to thyroid cancers. Opinions on number of potential deaths differ.

Bidwai claimed (34,000 to 95,000) deaths, lot less than one million predicted by a Greenpeace supported report. He claimed that the numbers of deaths are still “climbing”. Such myths cloud the reality that no such dramatic increases have been identified. Actually radiation scaremongers caused 100,000 to 200,000 abortions in Europe!

A nuclear reactor will not explode like a nuclear bomb as its fuel contains only less than 5% enriched uranium. This is a basic lesson in reactor physics. Bidwai’s argument that a reactor is a barely controlled nuclear bomb has no scientific basis.

Bidwai recommends that “there are perfectly sound, safe, cost-competitive renewable energy alternatives to nuclear power”. We do not now have the luxury to choose any mode of power generation. The Government’s programme to erect solar generating capacity of 20,000 MWe by 2020, equal to that of the then nuclear capacity may be seen in that context.. On a percentage basis, India now produces more renewable energy than Germany.

Ranked fifth in the world, India’s installed wind-power capacity is 14,158 MW, three times our nuclear power capacity.

Recently, an energy specialist showed that under realistic assumptions, India will not be able to maintain a modest  annual per capita power need of about 2000 kWh by 2070 by  renewable energy alone; the maximum potential for renewable will be 36.1%. (Current Science, Sept 10, 2011), Fossil fuel and nuclear will continue to play their role. He believes that hundred years later, India has to depend on nuclear power only.

A Mumbai daily quoted Dr M P Parameswaran, a DAE veteran (whatever that may mean) as saying that “No N-plant in India safe”-an opinion, not based on facts.

“We are yet to master the technology to decommission a reactor. That is why we keep on extending the life period of some of the reactors which have outlived their utilities”, he added another skewed opinion.

Like other anti nuclear activists, he believes that since 1977, USA has not built any new nuclear power plant. There is a little confusion here. It is true that USA has not issued any new licence to construct a nuclear power plant.

Electric companies connected 50 out of the 104 currently operating nuclear power plants in USA to the grid after 1979, the year in which the Three Mile Island accident occurred. Nineteen of them after 1986, the year in which the Chernobyl accident occurred. Fifty three out of the 59 French reactors came on line after 1979.

He says that in 1974, all US Nobel Prize winners were opposed to nuclear power plants. It is very unlikely. In spite of the “opposition”, nuclear electricity has increased over seven fold during 1974 to 2010.

The one Nobel Laureate, Roald Hoffmann, I interviewed a few years ago, supports nuclear power; he wanted nuclear proponents to highlight its environmental advantages. Currently, Steven Chu, a Nobel Laureate is the US Energy Secretary ; he consistently votes for nuclear power

Dr Parameswaran asks why the Indian nuclear establishment is silent about the pollution caused to the marine wealth of the country by the coolant water discharged to the sea-another misconception!

A thermo-ecology study carried out at Kalpakkam and Kaiga stations with several experts from institutions such as the National Institute of Oceanography (NIO), Central Electro Chemical Research Institute (CECRI) and several universities in the country did not reveal any adverse impact on marine ecology near nuclear power plant sites.

With the erection, commissioning and operation of the reactors at Kudankulam, Indian scientists and engineers will demonstrate how they can effortlessly absorb and master Generation 3+ nuclear power technology. This will enable the country to face the challenges in electrical capacity addition with renewed vigour and confidence.

                       

                                                                                               -PTI Feature