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Radiation Medicine T he “human side ” of nuclear applications

Radiation Medicine T he “human side ” of nuclear applications. Pedro Andreo, Director Division of Human Health (NAHU) Department of Nuclear Sciences and Applications. BACKGROUND.

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Radiation Medicine T he “human side ” of nuclear applications

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  1. Radiation MedicineThe “human side” of nuclear applications Pedro Andreo, DirectorDivision of Human Health (NAHU) Department of Nuclear Sciences and Applications

  2. BACKGROUND • The utilization of radiation in medicine for diagnosis and treatment dates from the 19th century, almost from the time x-rays and radioactivity were discovered • Now its use is deeply embedded in medical practice. For many purposes, it is indispensable – both for diagnosis and for treatment Radiation Medicine

  3. THE DIVISION OF HUMAN HEALTH • Nuclear Medicine & Diagnostic imaging • Radiation Oncology & Cancer Treatment • Medical Physics & Dosimetry • Nutrition Radiation Medicine

  4. CONTENTS • “Nuclear” techniques in medicine:Radiation Medicine • What is and what is not “Nuclear Medicine” • The birth of PACT(Program of Action for Cancer Therapy) Radiation Medicine

  5. THREE DISTINCT FIELDS • Diagnostic radiology • 100% diagnostic • Radiotherapy • 100% treatment • Nuclear medicine • 80% diagnostic • 10% treatment • 10% lab tests Multidisciplinary team: physicians, physicists, radiographers,.. Radiation Medicine

  6. THREE DIFFERENT TYPES OFRADIATION SOURCES • Diagnostic radiology • X-rays • Radiotherapy • High-activity sealed sources radioisotopes, solid, capsule • Medical accelerators • Nuclear medicine • Low-activity unsealed sources (*) radioisotopes, mostly liquid radiopharmaceuticals(*) except for therapeutic uses Radiation Medicine

  7. DIAGNOSTIC X-RAYS The left hand of Mrs Roentgen, some 100 years ago(1895) Modern pelvic and thorax X-ray examinations using digital techniques Radiation Medicine

  8. Are X-rays atomic/nuclear? N bremsstrahlung interaction electron x-ray characteristicx-rays added Radiation Medicine

  9. The goal of Diagnostic Radiology A.L.A.R.A. To produce an anatomical or functional patient image (using x-rays) which is clinically useful …. …. delivering As Low radiation dose to the patient As Reasonably Achievable Radiation Medicine

  10. Mammography - the “ultimate” challenge with regard to X-ray image quality typically 25-30 kV;special anode-filter microcalcifications Radiation Medicine

  11. High-resolution imaging in 3D usingmulti-slice Computed Tomography techniquesand helical scanning 80-140 kV;typically 120 kV 1895 X Ray tube Detector array Radiation Medicine

  12. Angiography and interventional proceduresare performed using image intensifiers orflat panel detectors ~70-100 kV Radiation Medicine

  13. The goal of Radiotherapy A.H.A.R.A. … while keeping the dose to other regions and organs as low as possible. To deliver As High radiation dose As possible (Reasonably Achievable) to a “clinical target”… Radiation Medicine

  14. Teletherapy Sealed Co-60 source or electron/photon accelerator Radiation Medicine

  15. Modern accelerator teletherapy Radiation Medicine

  16. Brachytherapy sources Brachytherapy applicators Radiation Medicine

  17. Brachytherapy treatments Nasopharynx applicator Afterloader system (nasopharynx) Cervix applicator Afterloader system (cervix) Radiation Medicine

  18. Nuclear Medicine Therapy Laboratory Tumour markersMolecular biologyGene expression Diagnosis Oncology Cardiology Neurology Radiation Medicine

  19. NUCLEAR MEDICINE IN-VIVO APPLICATIONS (90%): Diagnosis and Therapy The fundamental principle is the use of “agents”, which localize in specific organs or tissues on the basis of their biochemical or physiological properties (radiopharmaceuticals) Radiation Medicine

  20. Detector: gamma camera Position X Position Y -> computer Energy Z PM-tubes Detector Collimator Radioactive source is inside the patient Radiation Medicine

  21. Tomographic acquisition - anatomical Radiation Medicine

  22. Dynamic acquisition - funcional Radiation Medicine

  23. Nuclear Cardiology Chronic Syndromes Stable angina; previous myocardial infarction • Diagnosis of Coronary Artery Disease (CAD) • Assessment of specific risk conditions: diabetes • Management of patients with known or suspected chronic CAD: • Assessment of disease severity • Risk stratification • Prognosis • Evaluation effects medical therapy and/or surgery Radiation Medicine

  24. Nuclear Neurology MRI 18-FDG-PET 3D E Tremor Parkinson MSA Control In several cerebral diseases: • Integrated diagnosis • Therapy assessment • Early detection ofdegenerative diseases Radiation Medicine

  25. Radionuclide Therapy Thyroid Cancer Metastatic cancers Iodine-131: the silver bullet Radiation Medicine

  26. Radionuclide Therapy: Established Role complementary tool to surgery, chemotherapy and radiotherapy • Differentiated thyroid carcinoma • Diffuse non-Hodgkin lymphoma • Metastatic neuro-endocrine tumours • Painful bone metastases 131I 131I-MoAb 111In-Octr 153Sm Radiation Medicine

  27. Radionuclide Therapy: emerging applicationsRadio Immuno Therapy (RIT) Radiation Medicine

  28. Molecular biology nuclear techniques are used in to detect drug resistance Radiation Medicine

  29. Detection of drug resistance: Tuberculosis, malaria, HIV Diagnosis of communicable diseases: Tuberculosis, Hepatitis, Chagas disease, Leishmaniasis, Dengue fever Diagnosis of genetic disorders: Fragile x-syndrome, thalassemia, sickle cell anemia Diagnosis of papilloma virus (associated with cervical cancer) Diagnosis of congenital hypothyroidism (associated with mental retardation) Nuclear Medicine in-vitro techniques Radiation Medicine

  30. PET imaging Radiation Medicine

  31. Multimodality imaging (image fusion) PET: function CT: anatomy Radiation Medicine

  32. THREE DIFFERENT TYPES OFRADIATION DOSE TO THE PATIENT • Diagnostic radiology (over 2 billions exam) • Low dose to patient (most exams) • Large population dose • Risk: stochastic effects • Radiotherapy (5.5 millions treatments) • High dose to patient (intended!) • Risk: deterministic and stochastic effects • Nuclear medicine (32 millions procedures) • Low doses (mostly) • Risk: stochastic effects Radiation Medicine

  33. “… it is likely that CT examinations will become the largest contribution to population dose from man-made exposures in many countries.” UNSCEAR, 2004 1895 1995 Radiation Medicine

  34. QUALITY ASSURANCE AND QUALITY CONTROL To optimize the dose delivered to a patient in clinical procedures, both diagnostic and therapeutic, so that the desired outcome of the medical prescription is achieved. MEDICAL PHYSICS: key player for the technical aspects of Radiation Medicine Radiation Medicine

  35. CANCER AND THE UN SYSTEMThe IAEA is the only UN player in Nuclear Technology transfer for cancer prevention, diagnosis and treatment • International Agency for Research on Cancer (IARC) • World Health Organization (WHO) Programme on Cancer Control • IAEA research and technical cooperation on nutrition, nuclear medicine and radiation therapy Radiation Medicine

  36. Nuclear techniques: an appropriate solutionfor cancer treatment and pain relief • Radiotherapy:Needed for at least 50% of cancer patients • Nuclear Medicine: Less frequent but effective for some wide-spread and diffuse cancers Radiation Medicine

  37. SOME FACTS • In the more industrialized countries,one person in threegets a cancer • For each one of us this means that, most likely, we will have one case of cancer among the closest members of our family Radiation Medicine

  38. Of the 260 million new cancer cases in 20 years, there will be approx 150 million in developing countries 100 million will be suitable for radiation treatment WHO-IARC (2003) Radiation Medicine

  39. IAEA resources are inadequate to respond to the silent crisis • In 10 years, approx 100 M$ for over 500 projects in 100 developing countries • At least $1-2 billion needed now • Demand will increase more than 50% over the next 20 years Radiation Medicine

  40. Programme of Action on Cancer Therapy(PACT) One House: Meeting Global Needs Radiation Medicine

  41. Programme of Action for Cancer Therapy (PACT) • Work with partners on prevention and control (Agency: radiation medicine) • Raise publicawareness • Mobilize resources Patient set-up for treatment with a 60Co teletherapy machine Radiation Medicine

  42. Programme of Action for Cancer Therapy(PACT) • Board of Governors approves June 2004 GOV/2004/39 • General Conference resolution Sept 2004 GC (48)13D • PACT Programme Office (PPO) established Nov 2005SEC/NOT/2048 Treatment using a High-Dose-Rate 192Ir brachytherapy machine Radiation Medicine

  43. Radiation Medicine

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