Andreo_Presentation.ppt djjdjsksksksksksjsnsn

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

Radiation Medicine 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

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

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)

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

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

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

Are X-rays atomic/nuclear?
bremsstrahlung
interaction
N
x-ray
electron
characteristic
x-rays added

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

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

1895
High-resolution imaging in 3D using
multi-slice Computed Tomography techniques
and helical scanning
X Ray
tube
Detector array
80-140 kV;
typically 120 kV

Angiography and interventional procedures
are performed using image intensifiers or
flat panel detectors
~ 70-100 kV

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

Teletherapy
Sealed Co-60 source or electron/photon accelerator

Modern accelerator teletherapy

Brachytherapy sources
Brachytherapy applicators

Nasopharynx applicator
Cervix applicator
Afterloader system (nasopharynx)
Afterloader system (cervix)
Brachytherapy treatments

Nuclear Medicine
Diagnosis
Oncology
Cardiology
Neurology
Therapy
Laboratory
Tumour markers
Molecular biology
Gene expression

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)

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

Tomographic acquisition - anatomical

Dynamic acquisition - funcional

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

Nuclear Neurology
In several cerebral diseases:
• Integrated diagnosis
• Therapy assessment
• Early detection of
degenerative
diseases
MRI 18-FDG-PET 3D
E Tremor Parkinson
Control MSA

Radionuclide Therapy
Thyroid Cancer Metastatic cancers
Iodine-131: the silver bullet

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

Radionuclide Therapy:
emerging applications
Radio Immuno Therapy (RIT)

Molecular biology nuclear techniques
are used in to detect drug resistance

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)

PET imaging

Multimodality imaging (image fusion)
CT: anatomy
PET: function

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

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

QUALITY ASSURANCE AND
QUALITY CONTROL
MEDICAL PHYSICS:
key player for the technical
aspects of Radiation Medicine
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.

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

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

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

approx 150 million
in developing
countries
100 million will be
suitable for
radiation treatment
0
2
4
6
8
10
1990 1995 2000 2005 2010 2015 2020
new
cancer
cases
per
year
(millions)
year
developing
countries
industrialized
countries
WHO-IARC (2003)
Of the 260 million new cancer cases in 20 years,
there will be

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

Programme of Action on Cancer Therapy
(PACT)
One House: Meeting Global Needs

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

Programme of Action for Cancer Therapy
(PACT)
Treatment using a High-Dose-Rate 192Ir
brachytherapy machine
• 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

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