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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. Давайте сделаем это Thank you Большое спасибо