nuclear sciences and medicine

IAEAInternational Atomic Energy Agency

Nuclear Sciences and Medicine

Rethy Chhem, MD, PhD (Edu), PhD (His), FRCPC

Division of Human Health

Guest Professor, Medical University of Vienna

IAEA

Medical Imaging

• X-rays

• CT, Micro-CT

• CT (3D images, Virtual reality )

• MRI

IAEA

World 1st X-ray of Mummy

1896 - Frankfurt, Germany

IAEA

1979

World 1st CT

Egyptian Mummy Toronto, Canada

Harwood-Nash DF

CT of Egyptian mummies.

JCAT, 3, 6, 768-773, 1979

IAEA

IAEA

IAEA

Hetep Bastet

IAEA

IAEA

Micro-CT Vertebra

IAEA

Micro-CT Vertebra

Normal Vs Hemangioma

IAEA

Did Ramesses II really have AS?

IAEA

1976

IAEA

IAEA

IAEA

1979

IAEA

Ramesses II

IAEA

Ramesses II

IAEA

Ramesses II

IAEA

Did Ramesses II really have AS?

No….!

It’s D.I.S.H.

2004

IAEA

New ScientistNovember 13, 2004

IAEA

PREVENTION

CLINICAL

ASSESSMENT

DIAGNOSIS

PROGNOSIS

STAGING

TREATMENT

RESTAGING

CT

MRI

US

Rx

NM(SPECT,

Markers)

PET

Chemotherapy RadTher

Surgery NM

CT

PET

NM(Markers)

Cancer Management

Oncology

IAEA

Division of Human Health

Nuclear Medical Technology in Cancer

Cancer

• Diagnostic

• Staging

• Response to treatment

IAEA

Detecting Cancer

IAEA

Division of Human Health

Ewing Tumor

IAEA

Division of Human Health

Ewing Tumor

IAEA

Staging tumor

IAEA

Division of Human Health

Ewing Tumor

IAEA

Division of Human Health

Metastases

IAEA

Division of Human Health

PET & CT

IAEA

Planning treatment

IAEA

Division of Human Health

CT vs PET/CT

IAEA

Response to treatment

IAEA

Division of Human Health

Tumor Response to Treatment

IAEA

Neurology

5%

Oncology

89%

Cardiology

3%

Others

2%

IAEA

• Diagnosis of malignancy

• Staging

• Assessing response to treatment

• Diagnosis & restaging of recurrence

• Therapy planning

• Predicting prognosis

Oncologic applications for FDG

PET/CT:

IAEA

Present Non-Oncological Indications (USA)

• Alzheimer’s disease

• Refractory seizures

• Myocardial viability

• Myocardial perfusion (Rb-82)

IAEA

Widespread metastases Single tumor site Normal study

FDG-PET in Cancer Patients

IAEA

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

PET/CT

IAEA FDG PET/CT

- Precise localization of malignant sites

IAEA

Brown fat and

muscle uptake

Differential diagnosis

of benign vs.

malignant sites

IAEA

Esophageal carcinoma with nodal metastases

674480

IAEA

• 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

IAEA

M, 84, primary colon ca, S/a resection, elevated CEA

Gastric adenocarcinoma on gastroscopy

IAEA

Increase

uptake in

bone marrow

IAEA

Lung Cancer, RUL

FDG-PET for staging

Physiologic uptake in esophagus

PET/CT

Accurate localization of

metastatic adenopathy

and exclusion of N3 disease

IAEARP

11/07/03

Rectum cancer resected in 08/2002, followed by chemo and radiation therapy until 01/2003.

Hepatic metastases resected in 04/2003.

05/2003 – CT scan - solitary pulmonary nodule

10/2003 – CT scan – unchanged

CEA level = 5,00.

Asymptomatic.

37 year old male

IAEARP

11/07/03

IAEA

Initial study - July 2.00 Evaluation post therapy

May 2005

Lymphoma

Treatment chemotheraphy

IAEAInternational Atomic Energy Agency

Science and development

Science and diplomacy

IAEAInternational Atomic Energy Agency

What exactly does the IAEA do?

IAEA

Mission

Three pillars:

• Safeguards & verification

• Safety & security

• Science & technology

Maximizing the contribution of nuclear technology to society,

while verifying its peaceful use

IAEA

Department of Safeguards

Ensuring that nuclear material is not diverted from peaceful

nuclear activities by verifying Member State declarations

IAEA

Department of Safety & Security

Helping countries upgrade nuclear safety and

prepare for and respond to emergencies

SafetyInternational 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

IAEA

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

IAEA

Department of Technical Cooperation

• 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

Transferring nuclear and related technologies for

peaceful uses to countries throughout the world

IAEA

Department of Management

Services:

• Budget and finance

• Human resources

• Information technology

• Conference and document services

• General services

• Common services

• Public Information

Contributing to the effective and efficient running of the

Agency’s programmes and services

IAEA

Dept of Nuclear Sciences and Applications

Programmes in:• food and agriculture (with FAO)

• human health

• industry

• water resource management

• protection of marine and terrestrial environment

• Special programme: PACT

Contributing to sustainable development through the

use of nuclear sciences and their applications

IAEA

IAEA’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

IAEA

2005 Nobel Peace PrizeIAEA 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.”

IAEA

Division of Human Health

Mission

Enhancing human health

using nuclear knowledge through

• Service

• Education

• Research

IAEA

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

IAEA

Division of Human Health

Human Diseases

• Communicable diseases

• Non-communicable diseases:

- Cardiovascular D

- Cancer

- Musculoskeletal

- Metabolic, etc

IAEA

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

IAEA

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

IAEA

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

IAEA

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

IAEA

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

IAEAInternational Atomic Energy Agency

IAEA

Division of Human Health

2. Medical Imaging and NM

Coronary Artery Disease

• Diagnosis

• Severity

• Risk stratification

• Prognosis

• Response to treatment

IAEA

2. Medical Imaging and NM

Neurology

• Integrated diagnosis

• Therapy assessment

• Early detection of

degenerative diseases

MRI 18-FDG-PET 3D

E Tremor ParkinsonControl MSA

IAEA

Nuclear Medicine

Diagnosis Oncology

Cardiology

Neurology

TherapyLaboratoryTumor markers

Molecular biology

Gene expression

2. Medical Imaging and NM

IAEA

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

IAEA

Division of Human Health

3. QA & Metrology in Radiation Medicine

Worldwide QA and standardization in Diagnostic

Radiology

New X-ray calibration facility

IAEA

3. QA & Metrology in Cancer Treatment

IAEA7/17/2009 75

• 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

4. Radiotherapy & Radiobiology

IAEA

4. Radiotherapy & Radiobiology

•100 TC projects in RT/70

countries.

•Capacity building through

“educating the educators”

•QA

IAEAThank you