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Atoms for Health
Prof. Dr. Werner Burkart
Skolkovo Conference on:
Accelerators and Radiation Technologies for the
Future of Russia
Saint Petersburg, 28-29 September 2012
Radiation Medicine is the Cornerstone of
Atoms for Peace
• All 156 IAEA Member States use some elements of
Radiation Medicine
but only 30 Member States have Nuclear Power
Plants, less than 20%
• Radiation Medicine contributes in unique ways to
screening, diagnosis, therapy and control, palliation
• Socio-Economic Aspects of
Radiation Medicine:
PET/CT
> € 1,000
proton Therapy
> € 50,000
but still competitive with Chemotherapy
What do 80 Millionen People Need?
Health Care
800,000 Hospital Beds
260,000 Practicing Physicians
50,000 X-ray Machines
240 Radiation Therapy
Units with Complex
Imaging, Planning
Hardware
Annual costs: € 320 billion (4 k€
capita-1 a-1 in Norway  10% of GNP)
Nuclear part: up to 15%?
Treating Cancer:
Nuclear Technologies Today
Fused
image
Improved cancer diagnosis using multimodality imaging ‘fusion’ of
PET (left) and CT (right) images.
 The bottom picture shows theServing
combined
(fused) image
Basic Human Needs
5
Role of Radiation Medicine in Cancer Management:
Planning Treatment
CT versus PET/CT
Atoms for Health
Here: External Beam Radiotherapy
Serving Basic Human Needs
7
Role of Radiation Medicine
in Cancer Management
DIAGNOSIS
CLINICAL
ASSESSMENT
CT
PET
NM
STAGING
PROGNOSIS
FOLLOW UP
TREATMENT
Chemotherapy, Radiotherapy,
Surgery
CT
MRI
US
XRay
NM
PET
Radiotherapy Treatment Units per Million
Radiotherapy
programmes offered by
the IAEA are an essential
part of the treatment of
cancer
There is a shortfall of over
5 000 radiotherapy
machines in developing
countries
Radiotherapy Treatment Units per Million
Recommendation would be 4-5 teletherapy units per million.
Each teletherapy units can comfortably treat 500
radiotherapy patients/year
Positron ( ß+) emission
511 keV
A
X
Z
++n
Y
+
b
Z-1
A
g
Two anti-parallel 511 keV
Photons produced
PP
N
P
N P
NP N N
N
Unstable parent
nucleus
+ +
_
_
+
PP
+
e
+
_
Positron combines with
Electron and annihilates
_
N
P
N
N
NP N PN
N
Proton decays to
Neutron in nucleus –
positron and
neutrino emitted
e e+
180o
g
511 keV
n
Properties of commonly used positron emitting radioisotopes
Isotope
Half-life
(min)
11C
Maximum
positron
energy
(MeV)
Positron range in Production
water
method
(FWHM in mm)
20.30
13N
9.97
15O
2.03
18F
109.80
68Ga
67.80
0.96
1.19
1.70
0.64
1.89
1.1
1.4
1.5
1.0
1.7
cyclotron
cyclotron
cyclotron
cyclotron
generator
82Rb
3.15
1.7
generator
1.26
Radiation Medicine and Beyond
Challenges Ahead:
• RT has to show comparative advantage
• Improve attractiveness with other modalities:
• SPECT/MRI, PET/CT/MRI
Costs, human resources limiting
• Partner with IT for Imaging etc.
• Nuclear Medicine ready for Therapy,
but bottleneck specific delivery
 partner with genomics, proteomics
platforms
• Open for input by Nanotechnologies
• Convince Health Care System
Nanotechnology in Radiation Medicine
Bottom Up: Create selfassembling systems (copy
nature) at the molecular scale
 Drugs, skin, structural replacements, targeted delivery
• Radiation technologies to
analyze, understand
nanostructures
• New diagnoses, therapies
through nanostructures
loaded with radionuclides
Role of Radiation Medicine in Cancer Management:
QA Publications
Cancer: a Growing Epidemic
Cancer killed nearly
8 million people in
2008, almost 5 million
in less developed
regions
40%
of all cancer deaths
could have been
prevented
Sources: WHO, GLOBOCAN (2008)
Conclusions
• The disciplines of Radiation Medicine are central
and indispensible elements of medical imaging,
therapy and palliation.
• Technical progress is rapid but deployment in depth
hampered by steep increases in costs and limited
human resources.
• Further market penetration depends on partnering
with other modalities, cross-fertilization with nanoscience, genomics, proteomics.
• Good practice and a sound regulatory framework to
protect patients and medical staff is imperative.
Atoms for Health are unique, and at the centre
stage of Atoms for Peace.
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Thank you
Большое
спасибо