Nuclear Sciences and Medicine

Transcription

1 Nuclear Sciences and Medicine Rethy Chhem, MD, PhD (Edu), PhD (His), FRCPC Division of Human Health Guest Professor, Medical University of Vienna International Atomic Energy Agency

2 Medical Imaging X-rays CT, Micro-CT CT (3D images, Virtual reality ) MRI

3 World 1st X-ray of Mummy Frankfurt, Germany

4 1979 World 1st CT Egyptian Mummy Toronto, Canada Harwood-Nash DF CT of Egyptian mummies. JCAT, 3, 6, , 1979

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7 Hetep Bastet

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9 Micro-CT Vertebra

10 Micro-CT Vertebra Normal Vs Hemangioma

11 Did Ramesses II really have AS?

12 1976

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15 1979

16 Ramesses II

17 Ramesses II

18 Ramesses II

19 Did Ramesses II really have AS? No.! It s D.I.S.H. 2004

20 New Scientist November 13, 2004

21 PREVENTION Cancer Management Oncology CLINICAL ASSESSMENT CT PET NM (Markers) RESTAGING TREATMENT DIAGNOSIS PROGNOSIS STAGING CT MRI US Rx NM (SPECT, Markers) PET Chemotherapy Surgery RadTher NM

22 Division of Human Health Nuclear Medical Technology in Cancer Cancer Diagnostic Staging Response to treatment

23 Detecting Cancer

24 Division of Human Health Ewing Tumor

25 Division of Human Health Ewing Tumor

26 Staging tumor

27 Division of Human Health Ewing Tumor

28 Division of Human Health Metastases

29 Division of Human Health PET & CT

30 Planning treatment

31 Division of Human Health CT vs PET/CT

32 Response to treatment

33 Division of Human Health Tumor Response to Treatment

34 Oncology 89% Cardiology 3% Neurology 5% Others 2%

35 Oncologic applications for FDG PET/CT: Diagnosis of malignancy Staging Assessing response to treatment Diagnosis & restaging of recurrence Therapy planning Predicting prognosis

36 Present Non-Oncological Indications (USA) Alzheimer s disease Refractory seizures Myocardial viability Myocardial perfusion (Rb-82)

37 FDG-PET in Cancer Patients Widespread metastases Single tumor site Normal study

38 PET/CT Metabolism Anatomy Image fusion The process of determining the geometric relationship between multiple imaging studies, in order to use information provided by one test in the context of the other modality

39 - Precise localization of malignant sites FDG PET/CT

40 Differential diagnosis of benign vs. malignant sites Brown fat and muscle uptake

41 Esophageal carcinoma with nodal metastases

42 71 year old male History of severe chronic obstructive pulmonary disease Suspicious lymph nodes were seen in routine chest X-ray and follow-up CT PET/CT scan found a 2x2cm solitary nodule in upper right lung

43 M, 84, primary colon ca, S/a resection, elevated CEA Gastric adenocarcinoma on gastroscopy

44 Increase uptake in bone marrow

45 Lung Cancer, RUL FDG-PET for staging PET/CT Accurate localization of metastatic adenopathy and exclusion of N3 disease Physiologic uptake in esophagus

46 37 year old male Rectum cancer resected in 08/2002, followed by chemo and radiation therapy until 01/2003. Hepatic metastases resected in 04/ /2003 CT scan - solitary pulmonary nodule 10/2003 CT scan unchanged CEA level = 5,00. RP Asymptomatic. 11/07/03

47 RP 11/07/03

48 Lymphoma Initial study - July 2.00 Evaluation post therapy May 2005 Treatment chemotheraphy

49 Science and development Science and diplomacy International Atomic Energy Agency

50 What exactly does the do? International Atomic Energy Agency

51 Mission Maximizing the contribution of nuclear technology to society, while verifying its peaceful use Three pillars: Safeguards & verification Safety & security Science & technology

52 Department of Safeguards Ensuring that nuclear material is not diverted from peaceful nuclear activities by verifying Member State declarations

53 Department of Safety & Security Helping countries upgrade nuclear safety and prepare for and respond to emergencies Safety International safety standards for the management and regulation of nuclear and radioactive material activities Security Help States prevent, detect, and respond to terrorist or other malicious acts and protect nuclear installations and transport against sabotage

54 Department of Nuclear Energy Fostering the efficient and safe use of nuclear power Support Member States with respect to: nuclear power programmes advanced nuclear technologies nuclear fuel cycle and waste management programmes energy system development, energy investment planning and energy-environment policy formulation Nuclear knowledge management

55 Department of Technical Cooperation Transferring nuclear and related technologies for peaceful uses to countries throughout the world Goal: contributing directly to sustainable development priorities How? provide skills and equipment Who benefits? 112 recipient countries in 2006 When? When nuclear technology is a better or complementary solution

56 Department of Management Contributing to the effective and efficient running of the Agency s programmes and services Services: Budget and finance Human resources Information technology Conference and document services General services Common services Public Information

57 Dept of Nuclear Sciences and Applications Contributing to sustainable development through the use of nuclear sciences and their applications Programmes in: food and agriculture (with FAO) human health industry water resource management protection of marine and terrestrial environment Special programme: PACT

58 s Role Today UN watchdog in non-proliferation of nuclear weapons Set international safety and security standards Contribute to the advancement of science and human development

59 2005 Nobel Peace Prize and Dr Mohamed ElBaradei for their efforts to prevent nuclear energy from being used for military purposes and to ensure that nuclear energy for peaceful purposes is used in the safest possible way.

60 Division of Human Health Mission Enhancing human health using nuclear knowledge through Service Education Research

61 Division of Human Health Primary objective: To enhance capacity of MS to meet basic human needs Primary outcomes: Efficient use by MS of nuclear knowledge in human health

62 Division of Human Health Human Diseases Communicable diseases Non-communicable diseases: - Cardiovascular D - Cancer - Musculoskeletal - Metabolic, etc

63 Division of Human Health Research Building capacity in research through Coordinated Research Projects, with a few leading to a doctoral degree in collaboration with academic partners

64 Division of Human Health Services Dosimetry: Accurate measurement of radiation exposure QA of equipments Good practice of medical imaging and radiotherapy in hospital settings, etc

65 Division of Human Health Education Goals: Building capacity in nuclear knowledge for HH through Seminars and workshops International, regional conferences Teaching materials Technical and scientific publications

66 Division of Human Health 4 Sections 1. Nutritional and Health-related Environmental Studies 2. Nuclear Medicine/Medical Imaging 3. Dosimetry and Medical Radiation Physics 4. Applied Radiation Biology and Radiotherapy

67 Division of Human Health 1. Nutrition and infectious diseases Aim: To enhance Member States capability to use nuclear techniques in strategies to combat malnutrition and to prevent and control infectious diseases

68 International Atomic Energy Agency

69 Division of Human Health 2. Medical Imaging and NM Coronary Artery Disease Diagnosis Severity Risk stratification Prognosis Response to treatment

70 2. Medical Imaging and NM Neurology MRI 18-FDG-PET 3D Integrated diagnosis Therapy assessment Early detection of Control E Tremor Parkinson MSA degenerative diseases

71 2. Medical Imaging and NM Nuclear Medicine Diagnosis Oncology Cardiology Neurology Therapy Laboratory Tumor markers Molecular biology Gene expression

72 Division of Human Health 3. QA & Metrology in Radiation Medicine Radiotherapy, NM and Radiology Accuracy of dose for optimal diagnostic and therapeutic purpose and for radioprotection

73 Division of Human Health 3. QA & Metrology in Radiation Medicine Worldwide QA and standardization in Diagnostic Radiology New X-ray calibration facility

74 3. QA & Metrology in Cancer Treatment

75 4. Radiotherapy & Radiobiology Regular Programme ( 50%) Coordinated Research Projects Treatment guides for common cancers Teaching syllabi, technical reports Technical Co-operation ( 50%) Training courses Fellowships, scientific visits Provision of equipment, experts 7/17/

76 4. Radiotherapy & Radiobiology 100 TC projects in RT/70 countries. Capacity building through educating the educators QA

77 Thank you