Atoms for Health. Atoms for Health The. Atoms for Health - Division of Nuclear Health - Dept of Nuclear Aplications P Andreo DIR-NAHU 1

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International Atomic Energy Agency Atoms for Health The human side of nuclear applications NUCLEAR APPLICATIONS IN HEALTH A UNIQUE

throughout the world Article II of the Statutes of IAEA Division of Human Health Department of Nuclear Sciences and Applications Atoms

from the 19th century, almost from the time x-rays and radioactivity were discovered Now its use is deeply embedded in medical practice.

DISTINCT FIELDS Diagnostic radiology 100% diagnostic Radiotherapy 100% treatment Nuclear medicine 80% diagnostic 10% treatment 10% lab

1 International Atomic Energy Agency Atoms for Health The human side of nuclear applications NUCLEAR APPLICATIONS IN HEALTH A UNIQUE MANDATE OF THE UN SYSTEM The Agency shall seek to accelerate and enlarge the contribution of atomic energy to health and prosperity throughout the world Article II of the Statutes of IAEA Division of Human Health Department of Nuclear Sciences and Applications Atoms for Health International Atomic Energy Agency 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 Atoms for Health 3 International Atomic Energy Agency THREE DISTINCT FIELDS Diagnostic radiology 100% diagnostic Radiotherapy 100% treatment Nuclear medicine 80% diagnostic 10% treatment 10% lab tests Multidisciplinary team: physicians, physicists, radiographers,.. Atoms for Health 4 International Atomic Energy Agency P Andreo DIR-NAHU 1

THREE DIFFERENT TYPES OF RADIATION SOURCES Diagnostic radiology

solid, capsule Medical accelerators Nuclear medicine Low-activity

radiopharmaceuticals (*) except for therapeutic uses The left hand

pelvic and thorax X-ray examinations using digital techniques Atoms

International Atomic Energy Agency Are X-rays X atomic/nuclear?

electron N x-ray characteristic x-rays added To deliver As Low

Reasonably Achievable A.L.A.R.A. in order to produce an image clinically useful.

2 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 The left hand of Mrs Roentgen, some 100 years ago(1895) DIAGNOSTIC X-RAYSX Modern pelvic and thorax X-ray examinations using digital techniques Atoms for Health 5 International Atomic Energy Agency Atoms for Health 6 International Atomic Energy Agency Are X-rays X atomic/nuclear? bremsstrahlung interaction The goal of Diagnostic Radiology electron N x-ray characteristic x-rays added To deliver As Low radiation dose to the patient As Reasonably Achievable A.L.A.R.A. in order to produce an image clinically useful. Atoms for Health 7 International Atomic Energy Agency Atoms for Health 8 International Atomic Energy Agency P Andreo DIR-NAHU 2

Mammography - the ultimate challenge with

multi-slice Computed Tomography techniques

9 International Atomic Energy Agency Atoms

H.A.R.A. To deliver As High radiation dose

clinical target while keeping the dose to

3 Mammography - the ultimate challenge with regard to X-ray image quality typically kv; special anode-filter High-resolution imaging in 3D using multi-slice Computed Tomography techniques and helical scanning kv; typically 120 kv microcalcifications Detector array X Ray tube Atoms for Health 9 International Atomic Energy Agency Atoms for Health 10 International Atomic Energy Agency Angiography and interventional procedures are performed using image intensifiers or flat panel detectors ~ kv The goal of Radiotherapy A.H.A.R.A. 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. Atoms for Health 11 International Atomic Energy Agency Atoms for Health 12 International Atomic Energy Agency P Andreo DIR-NAHU 3

4 Teletherapy Modern accelerator teletherapy Sealed Co-60 source or electron/photon accelerator Atoms for Health 13 International Atomic Energy Agency Atoms for Health 14 International Atomic Energy Agency Brachytherapy sources Brachytherapy treatments Nasopharynx applicator Afterloader system (nasopharynx) Brachytherapy applicators Cervix applicator Afterloader system (cervix) Atoms for Health 15 International Atomic Energy Agency Atoms for Health 16 International Atomic Energy Agency P Andreo DIR-NAHU 4

CANCER AND THE UN SYSTEM The IAEA is the only player in technology transfer for Radiotherapy apy Access to Radiotherapy International Agency for Research on Cancer WHO Programme on

Establishment of new radiotherapy centres Atoms for Health 18 International Atomic Energy Agency Of the 260 million new cancer cases in 20 years, there will be Programme of Action

150 million in developing countries 100 million will be suitable for radiation treatment Patient set-up for treatment with a 60 Co tele-therapy machine Cancer prevention and control

5 CANCER AND THE UN SYSTEM The IAEA is the only player in technology transfer for Radiotherapy apy Access to Radiotherapy International Agency for Research on Cancer WHO Programme on Cancer Control IAEA research and technical cooperation on radiation therapy International Atomic Energy Agency Modified radiotherapy protocols Clinical guides and manuals TC: Establishment of new radiotherapy centres Atoms for Health 18 International Atomic Energy Agency Of the 260 million new cancer cases in 20 years, there will be Programme of Action for Cancer Therapy (PACT) new cancer cases per year (millions) developing countries industrialized countries WHO (2003) year approx 150 million in developing countries 100 million will be suitable for radiation treatment Patient set-up for treatment with a 60 Co tele-therapy machine Cancer prevention and control Work with partners Raise public awareness Mobilize resources Atoms for Health 19 International Atomic Energy Agency Atoms for Health 20 International Atomic Energy Agency P Andreo DIR-NAHU 5

NUCLEAR MEDICINE IN-VIVO APPLICATIONS (90%): Diagnosis and Therapy 1. A radionuclide is tagged to a compound: Radiopharmaceutical 2. Administered to patient, injected or orally 3.

Computerized data is converted into images or analyzed 6.

6 NUCLEAR MEDICINE IN-VIVO APPLICATIONS (90%): Diagnosis and Therapy 1. A radionuclide is tagged to a compound: Radiopharmaceutical 2. Administered to patient, injected or orally 3. Body metabolizes the radiopharmaceutical as if it were a normal substance (organ specifity) 4. Radionuclide distribution in the body is measured with an external detector 5. Computerized data is converted into images or analyzed 6. Clinician can visualize or track organ function (even at a molecular level) and diagnose Radiopharmaceuticals Radionuclide Pharmaceutical Organ Parameter + colloid Liver RES Tc-99m + MAA Lungs Regional perfusion + DTPA Kidneys Kidney function 21 International Atomic Energy Agency Atoms for Health 22 International Atomic Energy Agency Detector: gamma camera Whole body scanning Position X Position Y -> computer Energy Z PM-tubes Detector Collimator Radioactive source is inside the patient! Atoms for Health 23 International Atomic Energy Agency Atoms for Health 24 International Atomic Energy Agency P Andreo DIR-NAHU 6

Tomographic acquisition Dynamic acquisition Atoms for Health 25 International Atomic Energy Agency Atoms for

bone pain IN-VITRO APPLICATIONS: Radionuclide based laboratory techniques Malaria drug resistance- A global

Conventional in vitro drug testing method takes up to 72 hours to perform.

(resistant to antimalarial SP) Parasites with Cys59 (sensitive to antimalarial SP) Mixture of parasites with

7 Tomographic acquisition Dynamic acquisition Atoms for Health 25 International Atomic Energy Agency Atoms for Health 26 International Atomic Energy Agency Thyroid Cancer Radionuclide Therapy Treatment for metastatic bone pain IN-VITRO APPLICATIONS: Radionuclide based laboratory techniques Malaria drug resistance- A global challenge! Malaria kills one person every 30 seconds in the world. Conventional in vitro drug testing method takes up to 72 hours to perform. Nuclear molecular methods are faster and more sensitive than conventional techniques Parasites with Arg59 (resistant to antimalarial SP) Parasites with Cys59 (sensitive to antimalarial SP) Mixture of parasites with Cys59 and Arg59 Image courtesy AJ Kazibwe & TG Egwang, MBL Uganda Atoms for Health 27 International Atomic Energy Agency Atoms for Health 28 International Atomic Energy Agency P Andreo DIR-NAHU 7

PET imaging Multimodality imaging (image fusion) PET: function CT: anatomy Atoms for Health 29 International Atomic Energy Agency Atoms for

organisation has specific mandate for promoting Nuclear Medicine 31 International Atomic Energy Agency THREE DIFFERENT TYPES OF RADIATION

effects Radiotherapy (5.5 millions treatments) High dose to patient (intented!

8 PET imaging Multimodality imaging (image fusion) PET: function CT: anatomy Atoms for Health 29 International Atomic Energy Agency Atoms for Health 30 International Atomic Energy Agency NUCLEAR MEDICINE The IAEA is the only UN organisation with a programme No other international organisation has specific mandate for promoting Nuclear Medicine 31 International Atomic Energy Agency 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 (intented!) Risk: deterministic and stochastic effects Nuclear medicine (32 millions procedures) Low doses (mostly) Risk: stochastic effects Atoms for Health 32 International Atomic Energy Agency P Andreo DIR-NAHU 8

THE DIVISION OF HUMAN HEALTH Sections Nuclear Medicine Radiotherapy and Radiobiology Dosimetry and Medical Physics Nutrition 33 International Atomic

Medicine Dosimetry Laboratory and QA Networks 34 International Atomic Energy Agency MALNUTRITION is the main contributor to the burden of disease in

Body composition and energy metabolism Stable isotopes Bone density & fat distribution DEXA & CT Obesity Health-care for HIV/AIDS Low birth weight

9 THE DIVISION OF HUMAN HEALTH Sections Nuclear Medicine Radiotherapy and Radiobiology Dosimetry and Medical Physics Nutrition 33 International Atomic Energy Agency QUALITY ASSURANCE AND QUALITY CONTROL DISSEMINATION OF QA CULTURE MEDICAL PHYSICS: key player for the technical aspects of Radiation Medicine Dosimetry Laboratory and QA Networks 34 International Atomic Energy Agency MALNUTRITION is the main contributor to the burden of disease in developing world Improving Nutrition through Nuclear Science Vitamins and Minerals Stable and radio isotopes Food fortification and bio-fortification Body composition and energy metabolism Stable isotopes Bone density & fat distribution DEXA & CT Obesity Health-care for HIV/AIDS Low birth weight Maternal health Osteoporosis Obesity Atoms for Health 35 International Atomic Energy Agency Atoms for Health 36 International Atomic Energy Agency P Andreo DIR-NAHU 9

Stable isotopes for nutrition Knowledge Management Activities in Health: Educational Syllabus for education of Radiotherapy radiographers Syllabus on Medical Physics Distance assisted training

nuclear medicine project involving network of 15 countries in Latin America Atoms for Health 37 International Atomic Energy Agency Atoms for Health 38 International Atomic Energy Agency Knowledge

10 Stable isotopes for nutrition Knowledge Management Activities in Health: Educational Syllabus for education of Radiotherapy radiographers Syllabus on Medical Physics Distance assisted training programme for Technologists in Nuclear Medicine Distance assisted training programme for Radiation Oncology Trainees Deuterium dose to the mother Collection of saliva samples from the baby Tele nuclear medicine project involving network of 15 countries in Latin America Atoms for Health 37 International Atomic Energy Agency Atoms for Health 38 International Atomic Energy Agency Knowledge Management Activities in Health: Databases Natural Matrix Reference Materials, for Nutritional and Health-Related Environmental Studies Directory of Radiotherapy Centres (DIRAC), with the World Health Organization (WHO) IAEA/WHO Network of Secondary Standards Dosimetry Labs IAEA/WHO TLD Service, External Quality Audits in Radiotherapy Dosimetry Atoms for Health 39 International Atomic Energy Agency Knowledge Management Activities in Health: Dissemination of information Recent Publications Public information brochure: Improving Nutrition through Nuclear Science Public information brochure: A Silent Crisis TecDoc Design and Implementation of a Radiotherapy Programme TecDoc Implementation of High Dose Rate Brachytherapy in Developing Countries Practical radiation technical manual: Mould Room Techniques TRS: Commissioning and Quality Assurance of Computerized Radiation Treatment Planning Atoms for Health 40 International Atomic Energy Agency P Andreo DIR-NAHU 10

Human Health Using nuclear techniques to improve health around the world

Human Health Using nuclear techniques to improve health around the world With its wide range of activities and expertise in nuclear science and medicine, the IAEA is helping Member States use nuclear techniques