This document discusses the use of radiation in medicine, including its history, current applications, and the International Atomic Energy Agency's role. It describes how radiation is used in diagnostic radiology, radiotherapy, and nuclear medicine. The IAEA's Division of Human Health works in areas like nuclear medicine, radiation oncology, medical physics and more. It also outlines the IAEA's Programme of Action for Cancer Therapy (PACT) initiative to help more patients access radiation treatment for cancer.

1. 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

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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

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Radiation Medicine 3
THE DIVISION OF HUMAN HEALTH
•Nuclear Medicine &
Diagnostic imaging
•Radiation Oncology
& Cancer Treatment
•Medical Physics &
Dosimetry
•Nutrition

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Radiation Medicine 4
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)

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Radiation Medicine 5
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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Radiation Medicine 6
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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Radiation Medicine 7
DIAGNOSTIC X-RAYS
The left hand of
Mrs Roentgen, some
100 years ago(1895)
Modern pelvic and thorax
X-ray examinations using
digital techniques

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Radiation Medicine 8
Are X-rays atomic/nuclear?
bremsstrahlung
interaction
N
x-ray
electron
characteristic
x-rays added

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Radiation Medicine 9
…. 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.

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Radiation Medicine 10
microcalcifications
Mammography - the “ultimate” challenge with
regard to X-ray image quality
typically 25-30 kV;
special anode-filter

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Radiation Medicine 11
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

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Radiation Medicine 12
Angiography and interventional procedures
are performed using image intensifiers or
flat panel detectors
~ 70-100 kV

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Radiation Medicine 13
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.

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Radiation Medicine 14
Teletherapy
Sealed Co-60 source or electron/photon accelerator

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Radiation Medicine 15
Modern accelerator teletherapy

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Radiation Medicine 16
Brachytherapy sources
Brachytherapy applicators

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Radiation Medicine 17
Nasopharynx applicator
Cervix applicator
Afterloader system (nasopharynx)
Afterloader system (cervix)
Brachytherapy treatments

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Radiation Medicine 18
Nuclear Medicine
Diagnosis
Oncology
Cardiology
Neurology
Therapy
Laboratory
Tumour markers
Molecular biology
Gene expression

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Radiation Medicine 19
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)

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Radiation Medicine 20
PM-tubes
Detector
Collimator
Position X
Position Y -> computer
Energy Z
Detector: gamma camera
Radioactive
source is
inside the
patient

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Radiation Medicine 21
Tomographic acquisition - anatomical

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Radiation Medicine 22
Dynamic acquisition - funcional

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Radiation Medicine 23
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

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Radiation Medicine 24
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

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Radiation Medicine 25
Radionuclide Therapy
Thyroid Cancer Metastatic cancers
Iodine-131: the silver bullet

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Radiation Medicine 26
• 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

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Radiation Medicine 27
Radionuclide Therapy:
emerging applications
Radio Immuno Therapy (RIT)

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Radiation Medicine 28
Molecular biology nuclear techniques
are used in to detect drug resistance

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Radiation Medicine 29
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)

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Radiation Medicine 30
PET imaging

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Radiation Medicine 31
Multimodality imaging (image fusion)
CT: anatomy
PET: function

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Radiation Medicine 32
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

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Radiation Medicine 33
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

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Radiation Medicine 34
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.

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Radiation Medicine 36
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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Radiation Medicine 37
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

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Radiation Medicine 38
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

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Radiation Medicine 39
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

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Radiation Medicine 40
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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Radiation Medicine 41
Programme of Action on Cancer Therapy
(PACT)
One House: Meeting Global Needs

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Radiation Medicine 42
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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Radiation Medicine 43
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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Radiation Medicine 44