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Application of Radiation in
Medicine and Research

Acknowledgements
Dr. N. Raman, Chairman, INSPIRE Science Camp -2013, KA...
RMN, 2013

7

RMN, 2013

8

The Electromagnetic Spectrum

What is Radiation?

Waveform of Radiation

• Radiation is a form...
Important Questions
1. How “artificial” radioisotopes are produced?

Cyclotron / Nuclear Reactors

2. Who
2 Wh supplies th...
Ref: http://www.slideshare.net/prayarhin/cancer2
RMN, 2013

19

Ref: NCI website

RMN, 2013

20

RMN, 2013

22

Ref: NCI w...
Ref: http://www.slideshare.net/prayarhin/cancer2
RMN, 2013

28

RMN, 2013

30

C
A
U
T
I
O
N
Ref: http://www.slideshare.ne...
Ref: http://www.slideshare.net/prayarhin/cancer2
RMN, 2013

Ref: http://www.slideshare.net/prayarhin/cancer2

31

RMN, 201...
Background of Diagnostic Radiology
Diagnostic x-rays have been used in medicine since the
late 19th century with steady an...
Fluoroscopy for interventional radiology

DR- Digital Radiography

Interventional radiology is a procedure in which fluoro...
What is Nuclear Medicine?
• uses radioactive materials for both diagnosis and
treatment

Nuclear
Medicine

• imaging docum...
IodineIodine-131

Scintillation Cameras
• Commonly known as
a “Gamma Cameras”

• Can be administered
in capsule or liquid
...
Radiation damages normal cells too!
Then what is the rationale for its
use?

• Radiation damages both cancer cells
and nor...
Growth Rate of Radiation Therapy Facilities in
India : 1990 - 2012
1990
Type of Unit
Teletherapy
py
(Co-60+LAs)
RAL Brachy...
Radiotherapy
py
Simulator

RMN, 2013

73
nehru@aerb.gov.in

Gamma Stereotactic Radiosurgery
“Gamma Knife”
• Uses numerous ...
Isotopes for endovascular
brachytherapy

Endovascular Brachytherapy
• uses radioactive catheters, pellets,
and stents to t...
PET Scanning
• Positron Emission Tomography (PET).
• Used to study physiologic and
biochemical processes within the body.
...
Ref: http://www.slideshare.net/santam/new-techniques-inRMN, 2013
radiotherapy

91

RMN, 2013

92

What is 3D?

Target
deli...
Proven Promises of IMRT
● Dose conformity & Dose Escalation
● Ability to treat complex shaped (concave or
convex) structur...
KV X-RAY ONBOARD
XIMAGING

Ref: Khan: The Physics of Radiation Therapy, 4th Ed. (2009), Ch. 25
RMN, 2013

103

RMN, 2013

...
3.Radiation Protection

Radiological Accident at Goiania

ICRP 85
RMN, 2013

109
nehru@aerb.gov.in

QA frequency of each t...
Radioisotopes + Molecular Imaging + Nanotechnology + Research Applications

CONCLUSIONS
•

The invaion of Scientific techn...
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Transcript of "Handout rmn-lecture-application of radiation-in-medicine-and-research-30-12-2013"

  1. 1. Application of Radiation in Medicine and Research Acknowledgements Dr. N. Raman, Chairman, INSPIRE Science Camp -2013, KASC, Erode Dr. A. K. Vidya & Dr. Deepa, and the Team Members of INSPIRE Science Camp, KASC, Erode Google Team Dr.R.M.Nehru IAEA, WHO, NCI, DST & AERB Information and Technical Services Division Atomic Energy Regulatory Board Niyamak Bhavan, Mumbai – 400 094 TMH & YOU AERB RMN, 2013 Note: Delivered at the Department of Science & Technology (DST), Govt. of India sponsored Innovation in Scientific 1 Pursuit for Inspired Research (INSPIRE) Science Internship Camp on Dec.30, 2013 at KASC, Erode nehru@aerb.gov.in RMN, 2013 2 RMN, 2013 RMN, 2013 4 3 Outline….. 1.Introduction Pioneers •What is Radiation? •What is Cancer? 2. Application of Radiation in • • Diagnostic Radiology Nuclear medicine N l di i • Antoine Henri Becquerel Radiation Therapy 3. Research Applications 4. Radiation Accidents 5.Conclusion Ernest Rutherford (1871-1937) Pierre Curie (1859-1906) Marie Curie (1867-1934) 5 Wilhelm Conrad Roentgen (1845-1923) RMN, 2013 6 1
  2. 2. RMN, 2013 7 RMN, 2013 8 The Electromagnetic Spectrum What is Radiation? Waveform of Radiation • Radiation is a form of energy. • It is emitted by either the nucleus of an atom or an orbital electron. • It is released i th f i l d in the form of f electromagnetic waves or particles. NONIONIZING IONIZING Radio Infrared Microwaves Ultraviolet Visible light Gamma rays X-rays RMN, 2013 9 RMN, 2013 10 RMN, 2013 11 RMN, 2013 12 2
  3. 3. Important Questions 1. How “artificial” radioisotopes are produced? Cyclotron / Nuclear Reactors 2. Who 2 Wh supplies the “artificial” radioisotopes? li th “ tifi i l” di i t ? Board of Radiation Isotope Technology, Mumbai or Suppliers from abroad 3. Who supplies the radiation-generating equipment? Local suppliers or Suppliers from abroad Ref: http://www.britatom.gov.in/images/animated_webmaster.gif 13 RMN, 2013 14 RMN, 2013 15 RMN, 2013 16 RMN, http://basroc.rl.ac.uk/ 2013 17 RMN, 2013 18 Basic Safety Factors TIME DISTANCE SHIELDING Ref: www.nrc.gov 3
  4. 4. Ref: http://www.slideshare.net/prayarhin/cancer2 RMN, 2013 19 Ref: NCI website RMN, 2013 20 RMN, 2013 22 Ref: NCI website RMN, 2013 21 14 million cancer cases Diagnosed in 2012 8.2 million cancer deaths in 2012 4
  5. 5. Ref: http://www.slideshare.net/prayarhin/cancer2 RMN, 2013 28 RMN, 2013 30 C A U T I O N Ref: http://www.slideshare.net/prayarhin/cancer2 RMN, 2013 29 5
  6. 6. Ref: http://www.slideshare.net/prayarhin/cancer2 RMN, 2013 Ref: http://www.slideshare.net/prayarhin/cancer2 31 RMN, 2013 32 Applications of Radiation in Medicine Radiation in Medicine Diagnostic Radiography Therapy Nuclear Medicine Radiotherapy Teletherapy RMN, 2013 Brachytherapy RMN, 2013 33 Nuclear Medicine 34 nehru@aerb.gov.in Technological Challenges in Clinical management of tumours Justification of practice KEY ISSUES Net benefit positive Accurate diagnosis Optimization of protection Benign or malignant / grading ALARA Selection of appropriate therapies Dose limitation Surgical resection without compromising the neurological functions (gross / partial) Never to exceed Dose Limits Tumour response to treatment Tumour recurrence or radiation necrosis RMN, 2013 35 nehru@aerb.gov.in RMN, 2013 Courtesy: Dr. Rama Jayasundar, Dept. of NMR, AIIMS, New Delhi 36 6
  7. 7. Background of Diagnostic Radiology Diagnostic x-rays have been used in medicine since the late 19th century with steady and continual advances: 1895 : Discovery of x-rays (Röntgen), first clinical images 1920s : Barium contrast studies 1930s : Intravenous contrast media 1940s : Angiography 1950s :Fluoroscopic image intensifiers / catheterization techniques 1960s :Early work on rare-earth intensifying screens 1970s :Computed Tomography (CT) 1990s :Interventional radiological techniques; helical and multi-slice scanners RMN, 2013 37 nehru@aerb.gov.in RMN, 2013 38 nehru@aerb.gov.in Image processing Diagnostic Radiology X-ray photons transmitted through the structures under examination comprise the “x-ray (or radiological) image” that must then be converted into a visual image by interaction with an appropriate detector (image receptor) FILM IN Modern X-ray tube “Earlier” X-ray tube X-RAY TUBE HOUSING (ASSEMBLY) FILM OUT HIGH VOLTAGE CABLES Mobile unit LIGHT BEAM COLLIMATO R RMN, 2013 39 nehru@aerb.gov.in General Radiography X-ray facility X• provides static images using x-ray film and intensifying screens or digital image receptors. • RMN, 2013 40 nehru@aerb.gov.in Fluoroscopy • provides dynamic (real-time) images using electronic or digital imaging. It is used for the dynamic evaluation of functional disorders, guidance during biopsies, surgical procedures, etc. Chest stand It is commonly used for examinations of most body parts including the thorax, abdomen, pelvis, skull, spine, extremities, etc. Mobile unit RMN, 2013 41 nehru@aerb.gov.in RMN, 2013 42 nehru@aerb.gov.in 7
  8. 8. Fluoroscopy for interventional radiology DR- Digital Radiography Interventional radiology is a procedure in which fluoroscopic x-ray imaging guides the radiologist (or other specialist medical practitioner) during medical or therapeutic treatments such as: CR- Computed Radiography • • • • RMN, 2013 RMN, 2013 43 44 nehru@aerb.gov.in Computed Tomography (CT) Mammography •Mammography is the most reliable method by which to detect lesions in the breast. This x-ray technique can detect small tumors before clear clinical symptoms appears. • Breast examinations are carried out either by individual medical referral, p g or as part of a screening program. X-RAY TUBE ASSEMBLY cardiovascular and endovascular radiology neuroradiology (biopsies, embolization, etc.) percutaneous gastrointestinal interventions; and genitourinary radiology (biopsies, tumor ablation, stent placement, etc.) The early “translate-rotate” scanner developed into “rotaterotate” technology where both the x-ray tube and radiation detectors rotate around the patient. A thin (~1-10 mm) fan-shaped x-ray beam produce images as “slices” through the patient’s body. • Mammography x-ray systems use dedicated equipment (low potential generators, special anode x-ray tube and filtration, etc.) OPERATOR’S PROTECTIVE SCREEN COMPRESSION PLATE IMAGE RECEPTOR RMN, 2013 45 nehru@aerb.gov.in RMN, 2013 46 nehru@aerb.gov.in 2.Technological advances 2.Technological advances Multi-slice Spiral CT RMN, 2013 47 RMN, 2013 48 8
  9. 9. What is Nuclear Medicine? • uses radioactive materials for both diagnosis and treatment Nuclear Medicine • imaging documents organ function and structure • uses relatively small amounts of radioactive materials (radiopharmaceuticals) to diagnose and treat disease • radiopharmaceuticals are substances that are localized in specific organs, bones, or tissues • radiopharmaceuticals can be detected externally by special types of cameras: gamma or PET cameras. • cameras work in conjunction with computers to form images that provide data and information about the area of body being imaged RMN, 2013 49 nehru@aerb.gov.in RMN, 2013 50 nehru@aerb.gov.in What is Nuclear Medicine? RMN, 2013 51 Radiopharmaceuticals Most Commonly Used RMN, 2013 52 TechnetiumTechnetium-99m • In short, 99mTcO4- is added to a vial containing a chemical compound that will bind to the radionuclide and the result is a radiopharmaceutical which, after administration, will localize in the desired patient organ to later be stud ed/ aged with a ga ate studied/imaged t gamma ca e a a camera. • The primary radionuclide used for diagnostic Nuclear Medicine procedures is technetium-99m (99mTc). Others are I3 &Th-201 0 131 & • The primary radionuclide used for therapeutic Nuclear Medicine procedures is Iodine-131 (131I). Others are Sr-89, Sm-153 and Rh-186. RMN, 2013 53 nehru@aerb.gov.in RMN, 2013 54 nehru@aerb.gov.in 9
  10. 10. IodineIodine-131 Scintillation Cameras • Commonly known as a “Gamma Cameras” • Can be administered in capsule or liquid solution form. • Are used to show how the radiopharmaceutical p administered to a patient distributes itself throughout the body or in specifically targeted organs. • Special precautions must be implemented when administering this radionuclide. RMN, 2013 55 nehru@aerb.gov.in SPECT Cameras RMN, 2013 56 nehru@aerb.gov.in RESEARCH APPLICATIONS • Single Photon Emission Computed Tomography (SPECT) • The SPECT camera looks at a patient from different angles and is able to demonstrate very precise detail within the patient. RMN, 2013 57 nehru@aerb.gov.in RMN, 2013 58 The Science of Radiation Therapy • What does ionising radiation do? Radiotherapy py RMN, 2013 59 nehru@aerb.gov.in – Ionizing radiation deposits energy that injures or destroys cells by damaging their genetic material (DNA) making it impossible (DNA), for these cells to continue to grow. RMN, 2013 60 nehru@aerb.gov.in 10
  11. 11. Radiation damages normal cells too! Then what is the rationale for its use? • Radiation damages both cancer cells and normal cells, however the latter are able to repair themselves and function properly. properly • Cancer cells are more sensitive to radiation than normal cells and will, therefore, be destroyed at a greater rate • The radiation is confined, as much as possible, to the cancer RMN, 2013 Radiation Facilities in India (2011(2011-2012) Teletherapy Centres Teletherapy Facilities Co-60 Units Linear Accelerators Gamma Knife Tomotherapy /Cyberknife : 237 : 232 : 7 : 3+2 Brachytherapy Facilities Remote Afterloading Units (HDR/LDR) : 200/14 Manual Afterloading kits (Cs-137) : 61 Manual Afterloding Interstitial Applications (Ir-192): 20 Opthalmic Applicator : 42 61 nehru@aerb.gov.in Kilovoltage Equipment (150 - 400 kVp) : 319 RMN, 2013 62 nehru@aerb.gov.in Tele -Gammatherapy equipment The Greek word “tele” means “far away” • Typical “deep xray unit” Movement RMN, 2013 63 nehru@aerb.gov.in RMN, 2013 64 nehru@aerb.gov.in Bhabhatron Co-60 Teletherapy Machine GammaGamma-ray equipment Tele = Distance •Indigenously developed in India •Typical source activity used = 370 TBq (200 RMM) • Cobalt 60 – Very popular • Cesium 137 – Not popular • Principles are the same Front view RMN, 2013 65 nehru@aerb.gov.in Side view RMN, 2013 66 nehru@aerb.gov.in 11
  12. 12. Growth Rate of Radiation Therapy Facilities in India : 1990 - 2012 1990 Type of Unit Teletherapy py (Co-60+LAs) RAL Brachy (LDR & HDR) MIC Brachy MIS Brachy 2000 2006 2012 170 267 378 484 31 66 119 214 30 10 77 29 89 34 61 20 RMN, 2013 • Modern accelerators have a lot of treatment options, for example – X-rays or electrons ( (dual mode) ) – multiple energies • 3 X-ray energies • 5 or more electron energies 67 nehru@aerb.gov.in Medical Linear Accelerator RMN, 2013 68 nehru@aerb.gov.in Radiation Therapy 69 nehru@aerb.gov.in RMN, 2013 70 nehru@aerb.gov.in Courtesy: Meditronix Cor rporation, India RMN, 2013 Electron Accelerators Ref: http://www.slideshare.net/santam/new-techniques-inRMN, 2013 radiotherapy 71 RMN, 2013 72 12
  13. 13. Radiotherapy py Simulator RMN, 2013 73 nehru@aerb.gov.in Gamma Stereotactic Radiosurgery “Gamma Knife” • Uses numerous high-activity Cobalt-60 sealed sources whereby the radiation beams converge at a specified point of treatment. • Used for Cerebral Tumors Ref: http://www.slideshare.net/santam/new-techniques-inRMN, 2013 radiotherapy 74 The Greek word “brachy” means “short” Brachytherapy Radionuclide Half-life Photon Energy (MeV) Half-value Layer (mm lead) 226 Ra 1600 years 0.047 - 2.45 (0.83 ave) 8.0 222 Rn 3.83 days 0.047 - 2.45 (0.83 ave) 8.0 60 Co 5.26 years 1.17, 1.33 11.0 5.5 55 137 30.0 30 0 years 0.662 0 662 Ir 74.2 days 0.136 - 1.06 (0.38 ave) 2.5 Au 2.7 days 0.412 2.5 Cs 192 198 125 I 60.2 days 0.028 ave 0.025 Pd 17.0 days 0.021 ave 0.008 103 RMN, 2013 75 nehru@aerb.gov.in Brachytherapy Applications RMN, 2013 76 nehru@aerb.gov.in High Dose Rate Brachytherapy Brachy = Short Co-60 • Surface Mould • Intracavitary • Interstitial Dose rate >12 Gy/hr Ir-192 (370 GBq) RMN, 2013 77 nehru@aerb.gov.in RMN, 2013 78 nehru@aerb.gov.in 13
  14. 14. Isotopes for endovascular brachytherapy Endovascular Brachytherapy • uses radioactive catheters, pellets, and stents to treat coronary and peripheral vascular problems. • radiation can be ion implanted, plated, or encapsulated in a sealed source device attached to a guide wire used in the angioplasty procedure. • radioactive device can be either permanently implanted or removed via the guide wire following treatment of the effected vessel wall • Gamma sources: 192-Ir • Beta sources: 32-P, 90-Sr/Y, 188-Rh (Rhenium) February 1998 August 1998 Post-PTCA 6 Months Later Pre-PTCA Dose calculation RMN, 2013 TELETHERAPY 79 nehru@aerb.gov.in • RMN, 2013 80 nehru@aerb.gov.in Head complexity to handl multiple energies and multiple modalities – different flattening filters and scatterin foils on a ‘carousel’ – monitor chambers – collimators Cs-137/Co-60 based Teletherapy Phasing out to Advanced Medical Linear M di l Li accelerators /Cyberknife systems RMN, 2013 81 Ref: http://www.slideshare.net/santam/new-techniques-inRMN, 2013 radiotherapy 82 Advantages of MR non-invasive biochemical characterisation particularly useful in a sensitive organ like brain surgical resection without compromising the neurological functions can be done using functional MRI tumour response to treatment tumour recurrence or radiation necrosis RMN, 2013 Courtesy: Dr. Rama Jayasundar, Dept. of NMR, AIIMS, New Delhi 83 RMN, 2013 84 nehru@aerb.gov.in 14
  15. 15. PET Scanning • Positron Emission Tomography (PET). • Used to study physiologic and biochemical processes within the body. • Processes studies are blood flow, oxygen, glucose and fatty acid metabolism, amino acid t t b li i id transport, pH t H and neuroreceptor densities • PET scanning is, however, in very limited usage because of the high cost of setting up a PET department. Courtesy: IAEA Ref: http://www.cyberphysics.co.uk/topics/atomic/Accelerators RMN, 2013 /Cyclotron/Cyclotron%20.htm 85 RMN, 2013 86 nehru@aerb.gov.in Positron Emission Tomography (PET) Ref: http://www.sepscience.com/images//Articles/Issues/0212/Steinbach/FIG-1.jpg Courtesy: IAEA RMN, 2013 87 RMN, 2013 88 Figure 5 Treatment monitoring with fluorodeoxyglucose (FDG) PET and CT in a patient with locally advanced distal esophageal cancer (arrows) Permission obtained from the American Society of Clinical Oncology © Weber WA (2006) Positron emission tomography as an imaging biomarker. J Clin Oncol 24: 3282–3292 Weber WA et al. (2008) Technology Insight: novel imaging of molecular targets is an emerging area crucial to the development of targeted drugs Nat Clin Pract Oncol 5: 44–54 doi:10.1038/ncponc0982 RMN, 2013 Ref: http://cancergrace.org/cancer-101/tag/petscans/ 89 RMN, 2013 90 15
  16. 16. Ref: http://www.slideshare.net/santam/new-techniques-inRMN, 2013 radiotherapy 91 RMN, 2013 92 What is 3D? Target delineation RMN, 2013 93 RMN, 2013 94 Ref: www.unmc.edu Comparison of Conventional and IMRT Treatment Planning What is IMRT? IMRT stands for “Intensity Modulated Radiation Therapy” RMN, 2013 95 nehru@aerb.gov.in RMN, 2013 96 nehru@aerb.gov.in 16
  17. 17. Proven Promises of IMRT ● Dose conformity & Dose Escalation ● Ability to treat complex shaped (concave or convex) structures ● Sparing of critical normal structures ● Differential dose intensity delivery with altered fractionation Conventional RMN, 2013 97 nehru@aerb.gov.in RMN, 2013 98 IMRT/IGRT FLOW CHART Diagnosis Images: • X-ray • CT Scanner • Ultrasound • MRI •PET RMN, 2013 99 RMN, 2013 Immobilization Virtual Simulation Contouring Treatment Delivery dMLC Optimization 100 EPID • • • • • 101 Treatment Planning RMN, 2013 INTENSITY MODULATED RADIATION THERAPY (IMRT) • Treatment delivery step and Shoot method in Siemens ARTISTE Simulation Film Camera based EPID aSi based EPID (kV & MV) Orthogonal images BEV Matching RMN, 2013 102 17
  18. 18. KV X-RAY ONBOARD XIMAGING Ref: Khan: The Physics of Radiation Therapy, 4th Ed. (2009), Ch. 25 RMN, 2013 103 RMN, 2013 104 Dose escalation & decrease of risk of side effect RMN, 2013 3D CRT IMRT /IGRT Ref: Khan: The Physics of Radiation Therapy, 4th Ed. (2009), Ch. 25 105 RMN, 2013 106 Ref: www.unmc.edu RADIATION ACCIDENTS Ref: IAEA report on “THE RADIOLOGICAL ACCIDENT IN SAMUT PRAKARN” (2002) RMN, 2013 107 nehru@aerb.gov.in RMN, 2013 108 18
  19. 19. 3.Radiation Protection Radiological Accident at Goiania ICRP 85 RMN, 2013 109 nehru@aerb.gov.in QA frequency of each test RMN, 2013 110 QA test equipments.. •Probability of an error occurring. •Clinical consequences of the error. Daily or y weekly Monthly 6-Monthly 3 or 4Monthly RMN, 2013 Annual 111 RMN, 2013 112 Research Applications RMN, 2013 113 19
  20. 20. Radioisotopes + Molecular Imaging + Nanotechnology + Research Applications CONCLUSIONS • The invaion of Scientific technology is inevitable in medical specialties and continues to pose many challenges and issues • Best benefits using radiation could be derived by • • • • Understanding the strengths and limitations of systems, Proper Training /Education Following Stringent QA procedures Strict adherence to the Regulatory Compliance /Safety Culture • Bright Future is there for Scientific areas such as General and Applied Sciences (Radiological, Biochemical, Molecular Biology, Nanoscience ++) Ref: http://www.rikenresearch.riken.jp/images/figures/hi_4501.jpg RMN, 2013 115 RMN, 2013 RMN, 2013 116 117 20

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