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International Atomic Energy Agency
Radiation Medicine
The “human side” of nuclear applications
Pedro Andreo, Director
Division of Human Health (NAHU)
Department of Nuclear Sciences and Applications
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
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International Atomic Energy Agency
THE DIVISION OF HUMAN HEALTH
• Nuclear Medicine &
Diagnostic imaging
• Radiation Oncology
& Cancer Treatment
• Medical Physics &
Dosimetry
• Nutrition
Radiation Medicine
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International Atomic Energy Agency
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
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THREE DISTINCT FIELDS
• Diagnostic radiology
100% diagnostic
• Radiotherapy
100% treatment
• Nuclear medicine
80% diagnostic
10% treatment
10% lab tests
Multidisciplinary team: physicians, physicists, radiographers,..
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THREE DIFFERENT TYPES OF
RADIATION 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
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DIAGNOSTIC X-RAYS
The left hand of
Mrs Roentgen, some
100 years ago(1895)
Radiation Medicine
Modern pelvic and thorax
X-ray examinations using
digital techniques
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Are X-rays atomic/nuclear?
bremsstrahlung
interaction
electron
N
x-ray
characteristic
x-rays added
Radiation Medicine
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International Atomic Energy Agency
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 ….
Radiation Medicine
…. delivering As
Low radiation
dose to the
patient As
Reasonably
Achievable
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Mammography - the “ultimate” challenge with
regard to X-ray image quality
typically 25-30 kV;
special anode-filter
microcalcifications
Radiation Medicine
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High-resolution imaging in 3D using
multi-slice Computed Tomography techniques
and helical scanning
80-140 kV;
typically 120 kV
1895
X Ray
tube
Detector array
Radiation Medicine
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International Atomic Energy Agency
Angiography and interventional procedures
are performed using image intensifiers or
flat panel detectors
~ 70-100 kV
Radiation Medicine
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International Atomic Energy Agency
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
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International Atomic Energy Agency
Teletherapy
Sealed Co-60 source or electron/photon accelerator
Radiation Medicine
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Modern accelerator teletherapy
Radiation Medicine
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Brachytherapy sources
Brachytherapy applicators
Radiation Medicine
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Brachytherapy treatments
Nasopharynx applicator
Afterloader system (nasopharynx)
Cervix applicator
Afterloader system (cervix)
Radiation Medicine
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Nuclear Medicine
Diagnosis
Oncology
Cardiology
Neurology
Radiation Medicine
Therapy
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Laboratory
Tumour markers
Molecular biology
Gene expression
International Atomic Energy Agency
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
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International Atomic Energy Agency
Detector: gamma camera
Position X
Position Y -> computer
Energy Z
PM-tubes
Detector
Collimator
Radioactive
source is
inside the
patient
Radiation Medicine
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International Atomic Energy Agency
Tomographic acquisition - anatomical
Radiation Medicine
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Dynamic acquisition - funcional
Radiation Medicine
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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
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International Atomic Energy Agency
Nuclear Neurology
In several cerebral diseases:
MRI
• Integrated diagnosis
• Therapy assessment
• Early detection of
degenerative
diseases
Radiation Medicine
Control
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18-FDG-PET
E Tremor
Parkinson
3D
MSA
International Atomic Energy Agency
Radionuclide Therapy
Thyroid Cancer
Metastatic cancers
Iodine-131: the silver bullet
Radiation Medicine
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International Atomic Energy Agency
Radionuclide Therapy: Established Role
complementary tool to surgery,
chemotherapy and radiotherapy
•
Differentiated thyroid carcinoma
131I
•
Diffuse non-Hodgkin lymphoma
•
Metastatic neuro-endocrine tumours
131I-MoAb
111In-Octr
•
Painful bone metastases
Radiation Medicine
153Sm
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International Atomic Energy Agency
Radionuclide Therapy:
emerging applications
Radio Immuno Therapy (RIT)
Radiation Medicine
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International Atomic Energy Agency
Molecular biology nuclear techniques
are used in to detect drug resistance
Radiation Medicine
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International Atomic Energy Agency
Nuclear Medicine in-vitro techniques
•
•
•
•
•
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)
Radiation Medicine
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PET imaging
Radiation Medicine
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International Atomic Energy Agency
Multimodality imaging (image fusion)
PET: function
CT: anatomy
Radiation Medicine
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International Atomic Energy Agency
THREE DIFFERENT TYPES OF
RADIATION 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
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International Atomic Energy Agency
“… it is likely that CT examinations
will become the largest contribution
1895
1995
to population dose from
man-made
exposures in many countries.”
UNSCEAR, 2004
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International Atomic Energy Agency
QUALITY ASSURANCE AND
QUALITY CONTROL
MEDICAL PHYSICS:
key player for the technical
aspects of Radiation Medicine
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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.
International Atomic Energy Agency
CANCER AND THE UN SYSTEM
The 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
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International Atomic Energy Agency
Nuclear techniques: an appropriate solution
for 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
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International Atomic Energy Agency
SOME FACTS
• In the more industrialized countries,
one person in three gets 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
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International Atomic Energy Agency
Of the 260 million new cancer cases in 20 years,
there will be
new cancer cases per year (millions)
10
approx 150 million
in developing
countries
developing
countries
8
6
industrialized
countries
4
100 million will be
suitable for
radiation treatment
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WHO-IARC (2003)
0
1990
Radiation Medicine
1995
2000
2005
year
2010
2015
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2020
International Atomic Energy Agency
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
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International Atomic Energy Agency
Programme of Action on Cancer Therapy
(PACT)
One House: Meeting Global Needs
Radiation Medicine
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International Atomic Energy Agency
Programme of Action for Cancer Therapy
(PACT)
• Work with partners
•
•
on prevention and
control (Agency:
radiation medicine)
Raise public
awareness
Mobilize resources
Patient set-up for treatment with a
60Co teletherapy machine
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International Atomic Energy Agency
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 2005
SEC/NOT/2048
Treatment using a High-Dose-Rate 192Ir
brachytherapy machine
Radiation Medicine
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International Atomic Energy Agency
Radiation Medicine
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International Atomic Energy Agency