A brief presentation on application of nuclear radiations for healthcare

1. RADIATION FOR CANCER DETECTION
AND CURE
Madhava B Mallia
Radiopharmaceuticals Division
Bhabha Atomic Research Centre
Email: madhavmallia@rediffmail.com

2. Radiation
Radiation is the emission or transmission of energy in the form of
waves or particles through space or through a material medium
2
Low energy High energy
α, β

3. Radiation for healthcare applications
3
MRI
(Magnetic Resonance Imaging)
SPECT
PET
Cancer
Therapy

4. 4
4
Radioisotope
Radioactivity

5. 5
Radioisotopes
HEALTHCARE

6. Radioisotopes in healthcare
6
Brachytherapy Teletherapy
Radiopharmaceuticals
Can be used for diagnosis as well as therapy

7. Radiopharmaceuticals in healthcare
7
Cardiology Nephrology Neurology
Oncology

8. Oncology
8
Oncology - branch of medicine that deals with the prevention, diagnosis, and
treatment of cancer (Therapy)
Liver cancer Stomach cancer Lung cancer Breast cancer
Thyroid cancer Prostate cancer

9. Cancer
9
Cancer metastasis
Cancer - diseases in which abnormal cells divide without control and can
invade other parts of the body

10. How to detect cancer in body
• Challenge!!
– cancer is inside the body hence difficult to see
– It may be in one or many places (Metastasis)
• Solution?
– A safe to inject substance which can
accumulate preferentially in cancer cells and
send a signal that can be detected from
outside the body!!!
10

11. Radioisotope – A source for ‘signal’
11
Radioactivity is a phenomenon of spontaneous emission of
radiation by an unstable nuclei
Henri Becquerel
Unstable nucleus Stable nucleusRelease excess energy

12. Sources of radioisotopes
12
Nuclear reactors Cyclotrons

13. 13
Penetration - γ > β- / β+ > α
Which of the radiations can act as a ‘SIGNAL’ from inside the body?

14. 14
Highly penetrating gamma radiations can be used for diagnostic purposes
Radioisotopes emitting gamma/positron are called diagnostic radioisotopes
Alpha and beta radiations are used for therapeutic purposes
Radioisotopes emitting α or β- radiations are called therapeutic radioisotopes
positron
electron
What about positron (β+)
Annihilation
511 keV
Gamma
511 keV
Gamma

15. But…. How can we sent radioisotopes to cancer
tissue(s)?
15

16. 16
I know the way!!! I know Don’t the way!!!

17. Iodine knows its way to thyroid!!
17
Iodine
Thyroid has the ability to absorb
iodine from our diet
Thyroid utilizes iodine from out diet to
biosynthesize of T4 and T3
Hormone T4 Hormone T3
Monitoring iodine uptake can
provide functional status of
thyroid

18. 18
127I-
Non radioactive
123I-
Iodine-123
Half-life – 13.13 h
Gamma
124I-
Iodine-124
Half-life – 4.18 days
Positron
125I-
Iodine-125
Half-life – 60 days
Low energy gamma
131I-
Iodine-131
Half-life – 8 days
Gamma
beta
Radioisotopes of iodine behaves exactly the same as non-radioactive iodine
Cyclotron Nuclear Reactor

19. Normal thyroid Abnormal thyroid 1 Abnormal thyroid 2
Thyroid scans
Oral administration of Na 131I
Dose for diagnosis: 50 – 100 Ci
This is an example for use of radioisotope for organ function evaluation
Thyroid
19

20. 20
I know Don’t the way!!!

21. Radiopharmaceuticals
21
Radioisotope
+
Biomolecule
Like we have different buses for different destinations...
We have different radiopharmaceuticals for different cancers!
Radiopharmaceuticals

22. Diagnostic and therapeutic radiopharmaceuticals
22
+
Diagnostic
Radioisotope
Biomolecule Diagnostic
Radiopharmaceuticals
Examples for diagnostic radioisotopes:
Fluorine-18, Technetium-99m, Iodine-131, Gallium-68 etc.
+
Therapeutic
Radioisotope
Biomolecule Therapeutic
Radiopharmaceuticals
Examples for therapeutic radioisotopes:
Lutetium-177, Iodine-131, Yttrium-90 etc.

23. Cancer diagnosis using radiopharmaceutical
23

24. 18F-Fluorodeoxyglucose (FDG) for diagnostic imaging of
cancers: Mimicking Glucose
24
Mutation Formation of cancer

25. • Energy needed for cellular functions
• Energy comes from metabolism of glucose
25
Fast multiplying cells need more glucose

26. 18F-FDGGlucose
26

27. Gamma camera
Gamma scan
27
Is it a cancer?

28. Radiopharmaceuticals for diagnosis
28
18F-FDG
99mTc-Hynic TOC
68Ga-DOTA TOC
Prostate cancerNeuroendocrine cancers
68Ga-PSMA-11
Thyroid cancer
131I-Sodium iodide
18F-FDG
99mTc-Hynic TOC 68Ga-DOTA TOC
68Ga-PSMA-11

29. Cancer therapy using radiopharmaceutical
29

30. 30
How cancer therapy works?
How to kill a cell?
Deposit lot of energy and permanently damage vital molecules

31. What is better for therapy?
31
Gamma (massless, chargeless)
Beta (lighter mass, -1 charge)
Alpha (Heavier, +2 charge)
Matter/Tissue
Gamma  Interacts less  Looses less energy per unit length  Long Range
Beta  Moderate interaction  Looses moderate/high energy per unit length  Travels less
Alpha  Strong interaction  Looses significantly high energy per unit length  Travels least
LET – Linear energy transfer  Energy lost per unit length
LET – Alpha >>> Beta >>>>>>>>> Gamma
Alpha or Beta is preferred over Gamma for therapy

32. 32
Interaction with water
(indirect effect)
Interaction with DNA
or other macro
molecules
(direct effect)
80% of the cell is water

33. Direct route
33
• Single strand break
• Double strand break
•
•
•
• Cell death

34. 34
Indirect route

35. Thyroid cancer therapy
35

36. 36
Diagnostic dose: 50 – 100 Ci iodine-131
Therapeutic dose: 50 – 80 mCi
131I-
Iodine-131
Half-life – 8 days
Gamma
Beta - 666 keV
- 334 keV
Iodine knows its way to thyroid

37. 37
Peptide receptor radionuclidic therapy (PRRT)

38. 38
Somatostatin receptors on neuroendocrine cell membrane
Over expression of Somatostatin receptors on
neuroendocrine cancer cell membrane

39. Peptides for targeting neuroendocrine cancer
39
DOTA-TATE DOTA-TATE
Lutetium-177; Yttrium-90

40. Radiopharmaceuticals
177Lu-DOTA-TATE
40

41. 41

42. Radiopharmaceuticals therapy of cancer
42
177Lu-DOTA TATE
131I-MIBG
Prostate cancerNeuroendocrine cancers Liver cancer Breast cancer
177Lu-PSMA-617 131I-Lipiodol
188Re-Lipiodol
177Lu-Trastuzumab
Thyroid cancer
131I-Sodium iodide
177Lu-DOTA TATE
177Lu-PSMA-617

43. I hope….
• You understood how important are radioisotope in healthcare..
• How radioisotopes are used for cancer diagnosis and therapy..
• You will start seeing RADIATION in a different LIGHT
43
THANK YOU....
https://www2.slideshare.net/madhavmb
Email:madhavmallia@rediffmail.com

44. 44

45. Bhabhatron - For treatment of localized cancer
45
Bhabhatron is an indigenously developed
radiotherapy machine for the treatment of localized
cancers.
Advanced treatments are now possible using Multi Leaf Collimator with improved
conformity to irregular tumor boundaries.
Source of radiation is
cobalt – 60 (12 kCi)
(RAPPCOF, Rawatbhata)
For localized cancer
More than 60 centres in
India
10 countries

46. IMAGIN
An indigenously developed digital radiotherapy simulator
It reproduces the geometric conditions of a treatment machine (Bhabhatron).
Very useful for treatment planning and treatment plan verification before the actual
treatment of localized cancers.